Short vs long-course antibiotic therapy in adults with acute cholangitis: A systematic review, meta-analysis, and evidence quality assessment

Table 1 Baseline characteristics of the studies

Ref.	Country	Study period	Study design	Definition of AC	Population	Intervention	Outcomes
Ferstl et al[23], 2022	Germany	2008-2019	Retrospective observational study	TG18/TG13	Grade I and grade II AC after ERCP	Antibiotic therapy of 6 d	Recurrent cholangitis within 28 d
Kihara and Yokomizo[20], 2022	Japan	January 2009 to August 2018	Retrospective observational study	TG18/TG13	Postoperative cholangitis after pancreaticoduodenectomy	Antibiotic therapy and pancreaticoduoedenectomy	Clinical characteristics and outcomes in patients with acute cholangitis
Masuda et al[6], 2022	Japan	January 2018 to July 2020	Retrospective observational study	TG18/TG13	Grade I and grade II AC after successful ERCP	Antibiotic therapy of 3 d	30-d-mortality, recurrent cholangitis within 3 mo, length of hospitalization, in-hospital mortality
Sokal et al[14], 2022	France	2016-2018	Retrospective observational study	TG18/TG13	Patients with AC with and without malignant etiology	Cancer-associated AC	Duration of antibiotic therapy, 28-d-mortality, liver abscess
Masuda et al[17], 2021	Japan	April 2018 to March 2020	Retrospective observational study	TG18/TG13	AC patients with positive blood or bile culture and early ERCP	AC due to antibiotic resistant bacteria	Duration of antibiotic therapy, duration of hospitalization, in-hospital mortality, increased disease severity
Akhtar et al[18], 2020	Pakistan	June 2012 to June 2017	Cross-sectional observational study	TG18/TG13	AC patients without liver metastases or other reason for deranged liver function test. 70% of patients received ERCP	3-mo-mortality	Duration of antibiotic therapy, clinical severity, bacteremia
Haal et al[21], 2020	Netherlands	January 2012 to January 2017	Retrospective observational study	TG18/TG13	AC only due to stone in the common bile duct, without prior antibiotic therapy after ERCP	Antibiotic therapy of ≤ 3 d	3-mo-mortality, length of hospitalization, recurrent cholangitis, other complications
Satake et al[8], 2020	Japan	April 2014 to March 2019	Retrospective observational study	TG18/TG13	Grade I and grade II AC only due to choledocholithiasis who underwent ERCP	Antibiotic therapy of ≤ 3 d	30-d-mortality, length of hospitalization, recurrent cholangitis within 3 mo
Netinatsunton et al[16], 2019	Thailand	August 2017 to August 2018	Randomized controlled trial	TG18/TG13	AC only due to choledocholithiasis without presence of the Reynold´s pentad. Time to ERCP same between the study groups	Antibiotic therapy of ≤ 14 d	Recurrent cholangitis, length of hospitalization
Doi et al[22], 2018	Japan	January 2012 to February 2017	Retrospective observational study	ICD-10 and positive blood culture	AC and positive blood culture	Antibiotic therapy of ≤ 7 d	30-d-mortality, recurrent cholangitis within 3 mo (recurrence of symptoms)
Tagashira et al[13], 2017	Japan	January 2009 to December 2015	Retrospective observational study	TG18/TG13	Bacteriemic AC and ERCP where indicated	Adequate initial antibiotic therapy	Duration of antibiotic treatment, 30-d mortality
Uno et al[12], 2017	Japan	July 2012 to March 2014	Retrospective observational study	TG18/TG13	AC patients with gram-negative bacteriemia and after ERCP	Antibiotic therapy of ≤ 14 d	30-d mortality, recurrent cholangitis within 3 mo, antimicrobial treatment duration
Park et al[15], 2014	South Korea	September 2010 to November 2012	Randomized controlled trial	TG07	AC with bacteremia and ERCP within 24 h after admission	Intravenous antibiotic therapy of 6 d plus 8 d oral antibiotic therapy	30-d mortality, length of hospitalization, eradication of bacteria after 30 d
Kogure et al[19], 2011	Japan	September 2007 to August 2009	Retrospective observational study	TG07	Moderate and severe AC with ERCP	Antibiotic therapy of 3 d	Recurrent cholangitis
Van Lent et al[11], 2002	Netherlands	February 1999 to September 1999	Retrospective observational study	Fever > 38 °C and elevated bilirubin levels or bile duct dilatation in ultrasound	AC after successful ERCP. Exclusion of patients with primary sclerosing cholangitis, liver transplant recipients, bile duct atresia, inflammatory bowel disease	Antibiotic therapy of ≤ 3 d	6-mo mortality and recurrent cholangitis

AC: Acute cholangitis; TG18: Tokyo Guidelines 2018; TG13: Tokyo Guidelines 2013; TG07: Tokyo Guidelines 2007; ICD-10: The 10^th Edition of the International Classification of Diseases; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Quality assessment of the observational studies

	Ferstl et al[23], n = 115	Kihara and Yokomizo[20], n = 112	Masuda et al[6], n = 11	Sokal et al[14], n = 107	Masuda et al[17], n = 110	Akhtar et al[18], n = 55	Haal et al[21], n = 113	Satake et al[8], n = 101	Doi et al[22], n = 114	Tagashira et al[13], n = 106	Uno et al[12], n = 105	Kogure et al[19], n = 111	Van Lent et al[11], n = 104
Selection
Representativeness of exposed cohort	*	-	*	-	*	*	*	*	*	*	*	*	*
Selection of non-exposed cohort	*	*	*	*	*	*	*	*	*	*	*	*	*
Ascertainment of exposure	*	*	*	*	*	*	*	*	*	*	*	*	*
Demonstration that outcome of interest was not present at start of study	*	*	*	*	*	*	*	*	*	*	*	*	*
Comparability
Comparability of the cohorts	**	-	**	-	**	-	**	**	-	-	**	-	-
Outcome
Assessment of outcome	*	*	*	*	*	*	*	*	*	*	*	*	*
Was follow-up long enough for outcomes to occur?	*	*	*	*	*	*	*	*	*	*	*	*	*
Adequacy of follow-up cohorts	*	*	*	*	*	*	*	*	*	*	*	*	*
Overall	Good	Low	Good	Low	Good	Low	Good	Good	Low	Low	Good	Low	Low

*Represents study meets a criterion in each section of the Newcastle-Ottawa scale; -Represents study meets no criterion in each section of the Newcastle-Ottawa scale.