Approach to the management of acalculous cholecystitis in adults

* The choice of antibiotic depends on whether the infection is community-acquired or healthcare-associated, individual risk factors for infection with resistant bacteria, and risk for adverse outcomes. Refer to UpToDate content on acalculous cholecystitis and antimicrobial approach to intra-abdominal infections.
¶ Evaluate for comorbidities. Cholecystectomy is an alternative approach in patients at low surgical and anesthetic risk (eg, ASA class I or II).
Δ Failure to improve is defined as persistent fever, signs of sepsis, or evidence of new multiorgan dysfunction.
◊ The duration of antibiotic therapy depends on the adequacy of control of infection and the clinical stability of the patient. Refer to UpToDate content on acalculous cholecystitis and antimicrobial approach to intra-abdominal infections.
§ In patients with gallstones or sludge who are not surgical candidates, the cholecystostomy tube is removed when drainage is minimal.