Medicines to Treat Cholangitis

Definition

Also known as angiocolitis or choledochitis, cholangitis is defined as an "inflammation of the bile ducts and extrahepatic ducts, the cause of which resides, most of the time, in a bacterial insult. When the inflammation is accompanied by scarring and thickening of the ducts biliary, we speak more precisely of primary sclerosing cholangitis (in reference to a chronic inflammation of the bile ducts).

Causes

Most cholangitis is caused by bacterial infections (Escherichia coli, streptococci, salmonella, Pseudomonas, etc.) or parasitic (Ascaris lumbricoides or from Clonorchis sinensis), expression, in turn, of stones or in any case of mechanical obstructions affecting the biliary tract. Only rarely, cholangitis is the result of digestive diseases (appendicitis, duodenal diverticula, intestinal fistulas, etc.). The infection responsible for cholangitis can also be a consequence of surgical lesions. Rare, although possible, pancreatic juice reflux toxic cholangitis.

Symptoms

It is not possible to describe exactly the symptoms that distinguish cholangitis, since they are influenced by the etiological agent and the severity of the condition. In general, the most frequent symptoms include: chills, diarrhea, digestive difficulties, abdominal pain, intermittent fever , jaundice, general malaise, nausea, weight loss, vomiting.

The information on Cholangitis - Cholangitis Treatment Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Cholangitis - Medicines to Treat Cholangitis.

Medicines

Considering that, in most cases, cholangitis is the result of a bacterial attack, antibiotics are certainly the most appropriate drugs: by removing the pathogen, the inflammation of the bile ducts vanishes. Clearly, we have analyzed that cholangitis is closely associated with an "obstruction of the bile ducts (eg stones), therefore the treatment also and above all includes the treatment of the underlying cause: only in this way, the pathology can be completely reversed, thus ensuring the patient's recovery.

Although cholangitis can be resolved with rather simple therapeutic strategies, it is essential to intervene promptly: the disease, in fact, when not treated, can degenerate into very serious complications, up to jeopardizing the life of the subject: liver abscess, secondary biliary cirrhosis , renal failure and septic shock.

The following are the classes of drugs most used in the therapy against cholangitis, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Antibiotic drugs for the treatment of cholangitis: the choice of antibiotic is always dependent on the pathogen that triggered the infection.

• Levofloxacin (eg. Levofloxacin, Tavanic, Aranda, Fovex): belonging to the class of quinolones, levofloxacin is useful for treating cholangitis dependent on a "streptococcal infection. Indicatively, take 500 mg of the drug orally or intravenously. once a day, for one week, unless otherwise instructed by the doctor.
• Procaine + penicillin: it is a pharmacological preparation formulated with a penicillin associated with an anesthetic, which is also indicated for the treatment of cholangitis dependent on a "streptococcal infection: it is recommended to take 600-1000 units of drug per day by way of intramuscular, for at least 10 days It is also possible to associate benzathine (eg Fatromycin) with this antibiotic.
• Cipro (eg Ciprofloxac, Samper, Periactin): the drug belongs to the class of fluoroquinolones and is used in therapy for the treatment of cholangitis dependent on an "infection by E. coli. It is recommended to take 500 mg of the drug (tablets) every 12 hours; the duration of therapy is 5-7 days. Consult your doctor.
• Azithromycin (eg Azithromycin, Zitrobiotic, Rezan, Azitrocin): it is a macrolide antibiotic, indicated for the treatment of cholangitis dependent on E. coli infections. In the form of immediate-release tablets, it is recommended to take 500 mg of the drug on the first day, followed by 250 mg of active in the following 4 days. Consult your doctor for more information.
• Cefotaxime (eg Cefotaxime, Aximad, Lirgosin, Lexor): to treat infections caused by Pseudomonas and from salmonella in the context of cholangitis. As a guideline, take 1-2 grams of the drug intravenously or intramuscularly every 8 hours for 14 days.
• Gentamicin (eg. Gentamicin, Ciclozinil, Genbrix, Gentalyn): aminoglycoside antibiotic. For the treatment of cholangitis from Pseudomonas aeruginosa, it is recommended to administer 2 mg / kg of drug (loading dose) followed by 1.7 mg / kg i.v. every 8 hours; alternatively, administer 5 mg / kg (after the loading dose) every 24 hours. Continue with this dosage for 2 weeks.

Pain relieving and antispasmodic drugs for pain control: cholangitis is always accompanied by pain, therefore, when excessive, it may require the administration of muscle relaxing and anti-inflammatory drugs:

• Meperidine or Pethidine (eg Demerol, Petid C): opioid analgesic drug to be taken orally at a dosage of 50-100 mg every 4 hours, as needed. Or, intramuscularly / intravenously or subcutaneously, at a dosage of 25-100 mg every 4 hours. Alternatively, by slow intravenous infusion, it is recommended to administer the drug at a dosage of 25-50 mg (repeat after 4 hours). The dosages described above are indicated to mask the pain that cholangitis entails.
• Diclofenac (eg Fastum Painkiller, Dicloreum): preferable to pethidine. Take 50 mg of the drug orally 3 times a day (tablets); in some patients, a starting dose of 100 mg is required and then increased to 50 mg. After the first day, the total daily dose should not exceed 150 mg.
• Scopolamine butylbromide (eg Buscopan, Addofix, Erion): the drug is indicated to relax the smooth muscle of the genitourinary tract. It is recommended to administer 1-2 tablets of 10 mg 3 times a day for adults and children over 14 years of age. The drug is also indicated to appease vomiting in the context of cholangitis. In case of children between the ages of 6 and 14, it is essential to consult your doctor before taking the drug.
• Belladonna and papaverine hydrochloride (eg. Antispasmin colic): belladonna exerts an "anticholinergic action, reducing the spasm of smooth muscles (significant pain reduction). Take 2-6 sugared almonds - consisting of 10 mg of papaverine and 10 mg of belladonna. - per day for the average pain caused by cholangitis In case of severity, take 1-3 tablets of 50 mg of papaverine and 10 mg of belladonna per day.

Medicines to treat nausea and vomiting in the context of cholangitis: pain in the biliary tract may be so intense that it induces nausea and vomiting; therefore, the administration of antiemetic drugs can help alleviate these secondary symptoms. Antiemetics do not help in any way to cure the underlying cause. In this category, in addition to the scopolamine already analyzed previously, we remember:

• Metoclopramide (eg Plasil): belongs to the class of dopamine receptor blockers. It is an antiemetic and intestinal motility stimulator, also indicated to promote intestinal peristalsis and digestion. Injecting, take 10 mg of the drug, three times a day, preferably before meals. Also available in tablets and syrup.
• Domperidone (eg Motilium, Peridon): the drug is a stimulant of intestinal motility for the treatment of vomiting. It is recommended to take the drug at a dosage of 10-20 mg, 3-4 times a day, orally. Do not exceed 80 mg. The drug is also available in the form of 60 mg suppositories: apply 2 suppositories per day, as needed. It is also indicated for the treatment of vomiting associated with chemotherapy.
• Perfenazine (eg. Trilafon): in case of nausea and / or vomiting in the context of cholangitis, it is recommended to take the drug at a dosage of 8-16 mg, divided into several doses during the 24 hours.

For further information: see the article on drugs for the treatment of vomiting

Other drugs used in therapy for the control of cholangitis symptoms: cholangitis often manifests itself with an "alteration in the color of the skin, mucous membranes and sclera, which take on a yellowish color.

• Ursodeoxycholic acid or ursodiol (eg. Ursobil HT, Acido Ursodes AGE, Litursol): the administration of these drugs has proved particularly suitable for the dissolution of cholesterol stones of the gallbladder, especially if associated with jaundice and inflammation of the bile ducts ( cholangitis) The recommended posology is as follows: 8-12 mg / kg orally per day, in a single dose, in the evening or in two divided doses; prolong therapy for up to two years (maintenance therapy: 250 mg per day) The respect of the modality of taking the drug is essential for the healing of the disease (stones) and to cancel the secondary effects (in this case, jaundice). Consult your doctor.
• Chenodeoxycholic acid: is the most important bile acid produced by the liver. The active ingredient is used in therapy to help dissolve gallbladder stones, also in the context of jaundice and cholangitis; treatment with this drug is able to partially or totally dissolve gallbladder stones (made up of cholesterol) , thus resolving the jaundice dependent on gallbladder stones, hence cholangitis (in this specific case).