Cholangitis

1 to 2 g intravenously or intramuscularly, once daily or divided into two doses. Maximum 4 g daily, and no more than 2 g daily where renal and hepatic impairment are present together. - Continued in hospital: 4 to 7 days once the source of infection has been controlled, and a minimum of 2 weeks if there is bacteraemia with a gram-positive coccus such as Enterococcus or Streptococcus

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

(The Egyptian formulary gives 50 to 75 mg/kg as a single daily dose for mild to moderate infection in infants, children and adolescents, with a daily ceiling of 1,000 mg - and because it is given once a day, that ceiling is also the ceiling on the single dose. For severe infection the same monograph gives 100 mg/kg per day divided every 12 to 24 hours to a maximum of 4,000 mg a day, and a premature or term neonate is given 50 mg/kg every 24 hours. Acute cholangitis in a child is rare and is usually a complication of previous biliary surgery; which of those bands applies is a judgement for the admitting team.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255)

Two documents, each for a different claim. The Tokyo Guidelines 2018 name the agent: for grade I and grade II community-acquired acute cholangitis their cephalosporin-based options are cefazolin, cefotiam, cefuroxime, ceftriaxone or cefotaxime, and they state that antimicrobial therapy should be started before any percutaneous, endoscopic or operative drainage is performed - which is what makes a first dose in the clinic, on the way to hospital, the right move rather than a delay. The Egyptian formulary supplies the amount: it lists community-acquired intra-abdominal infection among ceftriaxone's indications and gives a general adult intravenous or intramuscular dose of 1 to 2 g once or twice daily. Egypt registers eight ceftriaxone injection products.

Covers acute ascending (bacterial) cholangitis — fever, jaundice, right upper quadrant pain — a biliary emergency needing same-day hospital admission for IV antibiotics and urgent biliary drainage (ERCP), as well as chronic autoimmune cholangitis (primary biliary cholangitis / primary sclerosing cholangitis) managed long-term with ursodeoxycholic acid under hepatology. GP starts empirical oral antibiotics only as a holding measure before urgent transfer for the acute form. - Refer, with advice

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

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

Covers acute ascending (bacterial) cholangitis — fever, jaundice, right upper quadrant pain — a biliary emergency needing same-day hospital admission for IV antibiotics and urgent biliary drainage (ERCP), as well as chronic autoimmune cholangitis (primary biliary cholangitis / primary sclerosing cholangitis) managed long-term with ursodeoxycholic acid under hepatology. GP starts empirical oral antibiotics only as a holding measure before urgent transfer for the acute form.