Acute Cholecystitis (Emergency Referral)

1 to 2 g intravenously or intramuscularly once daily, or the same total split into two doses. Maximum 4 g daily. - From admission until cholecystectomy - this is cover while the operation is arranged

50-75 mg/kg/dose [child max 1000 mg]

(Infants, children and adolescents, mild to moderate infection: 50 to 75 mg/kg per dose intramuscularly or intravenously once daily, maximum 1,000 mg per day; given once daily, that is also the per- dose ceiling above. Severe infection is dosed separately at 100 mg/kg/day divided every 12 to 24 hours. Acute cholecystitis is uncommon in childhood and usually acalculous or haemolytic in origin, and it is admitted.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) - general adult dosage 1 to 2 g intravenously or intramuscularly once daily or divided twice daily, maximum 4 g daily, with community-acquired intra-abdominal infection among the named indications.

The cholecystitis article's initial management is intravenous fluid resuscitation and prompt broad-spectrum antibiotics effective against gram-negative rods and anaerobes, followed by early laparoscopic cholecystectomy during the same admission because early surgery lowers morbidity and mortality against delayed surgery. Ceftriaxone is the formulary's agent for the gram-negative half. Eight 1 g products are marketed in Egypt.

500 mg intravenously or orally every 8 hours, as part of a combination - From admission until cholecystectomy - this is cover while the operation is arranged

22.5-40 mg/kg/day [child max 4000 mg]

(Infants, children and adolescents, intravenous: 22.5 to 40 mg/kg/day in 3 or 4 divided doses, maximum 4,000 mg per day. The oral band is different - 15 to 50 mg/kg/day in 3 divided doses, maximum 2,250 mg per day - so the route decides which applies; the grid above is the intravenous one.)

Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) - intra-abdominal infection, oral or intravenous 500 mg every 8 hours as part of an appropriate combination regimen, for 4 to 7 days following adequate source control.

The article asks for anaerobic cover explicitly and names no agent. Metronidazole is the formulary's anaerobe drug, dosed there for intra-abdominal infection as part of a combination, and Egypt stocks it as a ready-to-use 500 mg in 100 mL infusion.

Same-day hospital referral. Right upper quadrant pain with nausea, vomiting and intolerance of fatty food, plus Murphy's sign - inspiratory arrest during palpation of the right upper quadrant. This is not biliary colic that has gone on longer: colic settles, cholecystitis does not, and it is accompanied by fever and systemic upset. Ultrasound is the imaging of choice but the referral does not wait for it. - Refer, with advice

Rare in children and usually acalculous or associated with haemolytic disease; refer the same day.

No dose - referral pathway, no medicine given in primary care