Treatment: Acute Cholecystitis

No oral intake, nasogastric suction, IV fluids and electrolytes, analgesia (meperidine or NSAIDs), and antibiotics (ureidopenicillins, ampicillin sulbactam, ciprofloxacin, third-generation cephalosporins; anaerobic coverage should be added if gangrenous or emphysematous cholecystitis is suspected; imipenem/meropenem covers the spectrum of bacteria causing ascending cholangitis but should be reserved for the most life-threatening infections when other antibiotics have failed). Acute symptoms will resolve in 70% of pts. Optimal timing of surgery depends on pt stabilization and should be performed as soon as feasible. Urgent cholecystectomy is appropriate in most pts with a suspected or confirmed complication. Delayed surgery is reserved for pts with high risk of emergent surgery and where the diagnosis is in doubt.