Do Antibiotics Improve Post-Op Course Following Cholecystectomy?

Jean Marc Regimbeau Interview with :
Pr. Jean-Marc Regimbeau
Service de Chirurgie Digestive Oncologique et Métabolique,
CHU d’Amiens


Medical Research : What are the main findings of the study?

Answer: In our study we found that the absence of postoperative administration of amoxicillin plus clavulanic acid did not improve the occurrence of postoperative infections in patients with mild or moderate acute calculous cholecystitis. The bile cultures were pathogen free in 60.9% of case. Moreover we show that less than 2 percent of the overall population presented a major complication defined according to the Clavien Dindo Classification (Clavien score ≥3a). After cholecystectomy the readmission rate was 6%.

Medical Research : Were any of the findings unexpected?

Answer: All of the surgical results (operative time, conversion rate…) were concordant with the literature. Nevertheless we reported a perforation rate around 40%. This data, never reported in the articles, represents the daily practice. Moreover the patients with pathogens resistant to Amoxicillin plus clavulanic acid had similar length of stay and postoperative course.

Medical Research : What should clinicians and patients take away from your report?

The main data taken away from our study are :

  • Postoperative administration of amoxicillin plus clavulanic acid after mild or moderate acute calculous cholecystitis lasting for less than 5 days is not necessary (the treatment of this condition should include preoperative antibiotic and cholecystectomy)
  • Whatever the treatment course the readmission rate is around 6%.

Medical Research : What recommendations do you have for future research as a result of this study?

Answer: To improve the quality of the report some methodological aspects should be scheduled.

  • First the use of the placebo as a comparator (preferably a double placebo : one for the IV administration and one for the per os administration).
  • Secondly to schedule an alternative for antibiotic regimen in case of amoxicillin plus clavulanic acid allergy. Finally to obtain the reason of non inclusion as soon as the study begins.

Citation :

Last Updated on July 9, 2014 by Marie Benz MD FAAD