Ascending cholangitis is usually an infective cholangitis resulting in 'ascent' of enteric bacteria up the biliary tree. It is often characterised by Charcot's triad (which with features 4 and 5 forms Reynolds pentad):
- Identify underlying cause, e.g. gallstone disease.
- Aggressive supportive treatment for sepsis and sepsis-related organ dysfunction.
- Antibiotics, preferably after blood cultures. Ideally a broad spectrum antibiotic that concentrates in the bile, e.g. piperacillin/tazobactam (Tazocin®) and has activity against enteric Gram negative organisms such as E. coli and Klebsiella spp.
- ↑ Footnote: Some degree of cholestasis is common in this condition, which means that excretion of the antibiotic into bile observed in healthy volunteers may be only a theoretical advantage.