[보충] 담도계 감염의 항생제 요법

2018년 개정발표된 도쿄 가이드라인(Tokyo guidelines)(TG18)에서 제시한 항생제 요법을 소개하고자 한다.

증증도	Community-acquired biliary infections			Healthcare-associated biliary infections
증증도	Grade I	Grade II	Grade III	Healthcare-associated biliary infections
Penicillin 기반	Ampicillin/sulbactamb is not recommended if >20% resistance rate.	Piperacillin/tazobactam	Piperacillin/tazobactam	Piperacillin/tazobactam
Cephalosporin 기반	Cefazolin, or Cefotiam, or Cefuroxime, or Ceftriaxone, or Cefotaxime ± Metronidazole Cefmetazole, Cefoxitin, Flomoxef, Cefoperazone/sulbactam	Ceftriaxone, or Cefotaxime, or Cefepime, or Cefozopran, or Ceftazidime ± Metronidazole Cefoperazone/sulbactam	Cefepime, or Ceftazidime, or Cefozopran ± Metronidazole	Cefepime, or Ceftazidime, or Cefozopran ± Metronidazole
Carbapenem 기반	Ertapenem	Ertapenem	Imipenem/cilastatin, Meropenem, Doripenem, Ertapenem	Imipenem/cilastatin, Meropenem, Doripenem, Ertapenem
Monobactam 기반	(-)	(-)	Aztreonam ± Metronidazole	Aztreonam ± Metronidazole
Fluoroquinolone 기반	Ciprofloxacin, Levofloxacin, Pazufloxacin ± Metronidazole Moxifloxacin	Ciprofloxacin, Levofloxacin, Pazufloxacin ± Metronidazole Moxifloxacin	(-)	(-)

참고자료

Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018;25(1):3–16.