Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Harumi Gomi, Joseph S. Solomkin, David Schlossberg, Kohji Okamoto, Tadahiro Takada*, Steven M. Strasberg, Tomohiko Ukai, Itaru Endo, Yukio Iwashita, Taizo Hibi, Henry A. Pitt, Naohisa Matsunaga, Yoriyuki Takamori, Akiko Umezawa, Koji Asai, Kenji Suzuki, Ho Seong Han, Tsann Long Hwang, Yasuhisa Mori, Yoo Seok YoonWayne Shih Wei Huang, Giulio Belli, Christos Dervenis, Masamichi Yokoe, Seiki Kiriyama, Takao Itoi, Palepu Jagannath, O. James Garden, Fumihiko Miura, Eduardo de Santibañes, Satoru Shikata, Yoshinori Noguchi, Keita Wada, Goro Honda, Avinash Nivritti Supe, Masahiro Yoshida, Toshihiko Mayumi, Dirk J. Gouma, Daniel J. Deziel, Kui Hin Liau, Miin Fu Chen, Keng Hao Liu, Cheng Hsi Su, Angus C.W. Chan, Dong Sup Yoon, In Seok Choi, Eduard Jonas, Xiao Ping Chen, Sheung Tat Fan, Chen Guo Ker, Mariano Eduardo Giménez, Seigo Kitano, Masafumi Inomata, Shuntaro Mukai, Ryota Higuchi, Koichi Hirata, Kazuo Inui, Yoshinobu Sumiyama, Masakazu Yamamoto

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

237 Scopus citations


Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: Related clinical questions and references are also included.

Original languageEnglish
Pages (from-to)3-16
Number of pages14
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number1
StatePublished - 01 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery


  • Acute cholangitis
  • Acute cholecystitis
  • Antimicrobial therapy
  • Biliary tract infection
  • Treatment guidelines


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