🟡 Acute Cholangitis Severity & Management (TG18)
This tool grades acute cholangitis by Tokyo Guidelines TG18 and gives the biliary-drainage timing and empiric antibiotic direction.
Acute Cholangitis Severity & Management (TG18)
Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic)
Number of moderate criteria met (of 5)
When to use
Use to assign TG18 severity (organ dysfunction or moderate criteria) and time biliary drainage, from urgent in Grade III to response-based in Grade I.
How it works
Grade III = any new organ dysfunction → urgent drainage once stable. Grade II = ≥ 2 moderate criteria → early drainage. Grade I → antibiotics, drainage if no response within 24 h. ERCP preferred, PTBD if not feasible.
Key points
- Even mild (Grade I) cholangitis proceeds to drainage if antibiotics fail to control it within 24 hours. (original synthesis · not guideline verbatim)
- Empiric antibiotics target Gram-negative Enterobacteriaceae within 1 h for septic shock.
- Common-bile-duct stones are the leading cause, treated during or after drainage.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.