🟡 Acute Cholangitis Severity & Management (TG18)
This tool grades acute cholangitis by Tokyo Guidelines TG18 and gives the biliary-drainage timing and empiric antibiotic direction.
Clinical takeaway
Even mild (Grade I) cholangitis proceeds to drainage if antibiotics fail to control it within 24 hours. (original synthesis · not guideline verbatim)
Loading calculator…
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Present |
|---|---|
| Number of moderate criteria met (of 5) | 1 |
→SeverityGrade III (severe)
- Biliary drainage：Urgent biliary drainage once hemodynamically stable (ERCP preferred, PTBD if not feasible) + organ support
- Antibiotics：Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (within 1 h for septic shock, 4–6 h if no shock); course can be shortened after successful drainage (~3 days, or a few more days after source control)
- Cultures/etiology：Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage
| Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Absent |
|---|---|
| Number of moderate criteria met (of 5) | 1 |
→SeverityGrade I (mild)
- Biliary drainage：Antibiotics + support; if no response to initial treatment within 24 h, biliary drainage promptly
- Antibiotics：Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (within 1 h for septic shock, 4–6 h if no shock); course can be shortened after successful drainage (~3 days, or a few more days after source control)
- Cultures/etiology：Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage
Frequently asked questions
- What is Acute Cholangitis Severity & Management (TG18)?
- This tool grades acute cholangitis by Tokyo Guidelines TG18 and gives the biliary-drainage timing and empiric antibiotic direction.
- How is Acute Cholangitis Severity & Management (TG18) calculated? What is the core formula?
- 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.
- When is Acute Cholangitis Severity & Management (TG18) used?
- 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.
- What are the key clinical points for Acute Cholangitis Severity & Management (TG18)?
- 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.
- What are the limits and cautions when using Acute Cholangitis Severity & Management (TG18)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute Cholangitis Severity & Management (TG18) calculated in practice? Can you show a worked example?
- Inputs: Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Present, Number of moderate criteria met (of 5) 1 → Result: Severity Grade III (severe)（Biliary drainage: Urgent biliary drainage once hemodynamically stable (ERCP preferred, PTBD if not feasible) + organ support, Antibiotics: Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (within 1 h for septic shock, 4–6 h if no shock); course can be shortened after successful drainage (~3 days, or a few more days after source control), Cultures/etiology: Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage） Inputs: Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Absent, Number of moderate criteria met (of 5) 1 → Result: Severity Grade I (mild)（Biliary drainage: Antibiotics + support; if no response to initial treatment within 24 h, biliary drainage promptly, Antibiotics: Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (within 1 h for septic shock, 4–6 h if no shock); course can be shortened after successful drainage (~3 days, or a few more days after source control), Cultures/etiology: Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage）