Management of Biliary Colic

Diagnostic Approach

Ultrasound is the investigation of choice for patients with suspected biliary colic or cholecystitis, with key findings including gallbladder wall thickening, pericholecystic fluid, and Murphy's sign on ultrasound examination 1, 3, 4
If ultrasound is negative or equivocal but clinical suspicion remains high, additional imaging such as HIDA scan or MRCP may be warranted for suspected biliary disease 1, 5, 6, 7

Early laparoscopic cholecystectomy (within 7-10 days of symptom onset) is the recommended treatment for uncomplicated biliary colic/cholecystitis, with one-shot antibiotic prophylaxis and no post-operative antibiotics needed for uncomplicated cases 1, 2
For complicated cholecystitis, laparoscopic cholecystectomy remains the treatment of choice, with antibiotic therapy for 4 days in immunocompetent, non-critically ill patients and up to 7 days in immunocompromised or critically ill patients 1, 2

Amoxicillin/Clavulanate 2g/0.2g q8h is recommended for non-critically ill, immunocompetent patients, with alternative options for beta-lactam allergy such as Eravacycline or Tigecycline 1