{ "schema_version": 1, "kind": "condition", "id": "acute-cholecystitis", "name": "Acute Cholecystitis (Emergency Referral)", "category": "emergency", "sources": "Acute Cholecystitis - StatPearls, updated 6 July 2025 - https://www.ncbi.nlm.nih.gov/books/NBK459171/ · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) · 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. · 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.", "review_status": "reviewed", "verified_against": "Acute Cholecystitis - StatPearls, updated 6 July 2025 - https://www.ncbi.nlm.nih.gov/books/NBK459171/ · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) · 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. · 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.", "verified_date": "2026-08", "treatments": [ { "id": 41, "generic": "Ceftriaxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "1 to 2 g intravenously or intramuscularly once daily, or the same total split into two doses. Maximum 4 g daily.", "adult_duration": "From admission until cholecystectomy - this is cover while the operation is arranged", "dose_source": "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.", "rationale": "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.", "cautions": [ "GIVEN WITH METRONIDAZOLE, NOT ALONE - the article asks for cover against gram-negative rods AND anaerobes.", "The admission comes first and this is not started in a clinic. It is here so that the referral is an informed one and so a GP recognises the regimen the patient comes back on.", "Right upper quadrant pain that does not settle, with fever and systemic upset and a positive Murphy's sign, is not prolonged biliary colic. Colic settles; cholecystitis does not.", "Contraindicated in penicillin or cephalosporin hypersensitivity, and in the neonate receiving calcium-containing intravenous fluids.", "Where renal and hepatic impairment coexist, the formulary caps the daily dose at 2 g.", "Jaundice, rigors or a septic-looking patient suggests cholangitis or a stone in the common bile duct rather than simple cholecystitis, and changes the urgency." ], "peds_mgkg_low": 50.0, "peds_mgkg_high": 75.0, "peds_max_mg": 1000.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 500, "high_mg": 750, "capped": false }, { "weight_kg": 20, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 30, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 1000, "capped": true } ], "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-cholecystitis" }, { "id": 42, "generic": "Metronidazole", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 500.0, "adult_dose": "500 mg intravenously or orally every 8 hours, as part of a combination", "adult_duration": "From admission until cholecystectomy - this is cover while the operation is arranged", "dose_source": "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.", "rationale": "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.", "cautions": [ "GIVEN WITH CEFTRIAXONE, NOT ALONE. It covers anaerobes only.", "The admission comes first; this is what the receiving team gives.", "No alcohol during treatment or for 3 days after, and not within 2 weeks of disulfiram.", "Contraindicated in active neurological disorders, blood dyscrasia, hypothyroidism and hypoadrenalism, and in the first trimester where the indication is trichomoniasis.", "Halve the dose in severe hepatic impairment (Child-Pugh C).", "How long it runs after the operation is a separate question, and the two documents differ: the article gives antibiotics afterwards only where the gallbladder was gangrenous or perforated at operation, while the formulary's intra-abdominal figure is 4 to 7 days following adequate source control. Both are recorded; the operating team decides which applies.", "Where surgery is not an option, the article's alternative is percutaneous drainage of the gallbladder, decided by the hospital team." ], "peds_mgkg_low": 22.5, "peds_mgkg_high": 40.0, "peds_max_mg": 4000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 225, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 450, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 675, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 900, "high_mg": 1600, "capped": false } ], "brands": [ { "trade_name": "METRONIDAZOLE-OTSUKA 500MG /100ML I.V. INF. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAZOL 500MG/100ML I.V.INFUSION", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMRIZOLE 500 MG VIAL 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 47.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROFLAG 500MG/100ML VIAL FOR I.V. INF.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARABCOMED-EGYPT", "price_egp": 47.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-cholecystitis" }, { "id": 43, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": null, "cautions": [ "Untreated, StatPearls records gallbladder perforation as killing 30% of those it happens to.", "Hospital management is intravenous fluids and broad-spectrum antibiotics covering gram-negative rods and anaerobes, with laparoscopic cholecystectomy done early, on that same admission. (Acute Cholecystitis - StatPearls - NCBI Bookshelf, NBK459171) None of that is a primary-care prescription.", "Do not treat as biliary colic with an antispasmodic and analgesia at home once there is fever or a positive Murphy's sign.", "Jaundice, rigors or confusion suggest ascending cholangitis - that is an emergency admission, not a next-day referral." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Rare in children and usually acalculous or associated with haemolytic disease; refer the same day.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-cholecystitis" } ] }