Abstract
Five years have elapsed since the publication of the only one guideline concerning acute cholangitis, namely, “Japanese Guidelines for diagnosis of acute cholangitis and cholecystitis on scientific basis,” and this unified standard is now widely acknowledged and used. In the past, clear evidence to support antimicrobial therapy for acute cholangitis has been scant in not only Japan but also in Europe and the US, nevertheless verifications of the therapy have been conducted from several perspectives using the data accumulated so far. Various problems concerning antimicrobial therapy have been pointed out even in actual clinical practice using this guideline. It is important to revise the guideline further to make it more effective based on the evaluation of its effectiveness. This paper shows the difference between the current Japanese guideline and international counterparts, and also includes our suggestions for the revision of the guideline to make it more adaptable to the Japanese medical background, especially the section pertaining to “selection and administration methods of concrete antimicrobial therapies for each patient's condition,” which is the most problematic area in the therapy of acute cholangitis, for both acute cholangitis and acute cholecystitis.
