Table 5.

Antibacterials for moderate (grade II) and severe (grade III) acute cholecystitis

First options for moderate cases
Wide-spectrum penicillin/β-lactamase inhibitors	Piperacillin/tazobactam, ampicillin/sulbactam
Second-generation cephalosporins	Cefmetazole, cefotiam, oxacephem, flomoxef
First options for severe cases
Third- and fourth-generation cephalosporins	Cefoperazon/sulbactam, ceftriaxone, ceftazidime, cefepime, cefozopran
Monobactams	Aztreonam
One of above + metronidazole (when anaerobic bacteria are detected or are expected to co-exist)
Second options for severe cases
Fluoroquinolones	Ciprofloxacin, levofloxacin, pazufloxacin + metronidazole (when anaerobic bacteria are detected or are expected to co-exist)
Carbapanems	Meropenem, impenem/cilastatin, panipenem/betamipron