Q: Fluoroquinolones are found to be most effective antibiotics in acute cholangitis (given no resistance and good local profile). Even it has been shown that monotherapy with ciprofloxacin may be as effective as triple therapy with ceftazidime, ampicillin, and metronidazole. What is the reason? 


Answer:  Fluoroquinolones are very effective in acute cholangitis as in comparison to other antibiotics, they have high rates of biliary excretion. In case of Fluoroquinolones allergy or resistance, monotherapy with a beta lactam antibiotics is also good. At the end initial goal is to cover antibiotics that cover colonic bacteria, and later de-escalate/modify depending on growth of cultures.


Reference:

1. Leung JW, Ling TK, Chan RC, et al. Antibiotics, biliary sepsis, and bile duct stones. Gastrointest Endosc 1994; 40:716. 

2. Sung JJ, Lyon DJ, Suen R, et al. Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial. J Antimicrob Chemother 1995; 35:855.