LAUSR

During discussion at our journal club of Lan Cheong Wah et al.’s ‘Acute cholangitis: current concepts’, a few issues of concern were noted. The diagnostic criteria for acute cholangitis quoted are from the outdated Tokyo Guidelines of 2007, rather than the updated Tokyo Guidelines of 2013, which should have been considered under the terms of the search methodology described. The sensitivity of criterion was inadequate for clinical use and the revision had resulted in improved sensitivities from 82.6 to 91.8%, only reducing specificity from 79.8 to 77.7%. The current diagnostic criteria from Tokyo Guidelines of 2013 now have three diagnostic criteria, and a ‘suspected diagnosis’ section to further improve sensitivity (Table 1). The severity assessment has also changed drastically from Tokyo Guidelines 2007 to Tokyo Guidelines 2013, addressing early biliary drainage and aetiological treatment, with antimicrobial administration, as the fundamental treatments for all grades of acute cholangitis. Lan Cheong Wah et al. suggested that a penicillin/β-lactamase inhibitor such as piperacillin/tazobactam can be used as the initial antibiotic therapy. Current Australian therapeutic guidelines suggesting ampicillin and gentamicin as first line choice. The guideline choice provides optimal coverage of the most common pathogenic organisms as quoted within their paper. We hope that consideration of these concerns will aid in providing a more current concept on acute cholangitis.