American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment for patients with acute cholecystitis who do not improve with antibiotics?

1. Discharge with pain management

2. Urgent cholecystectomy

3. Switch to oral antibiotics

4. Observe for further complications

The correct answer is: Urgent cholecystectomy

The appropriate treatment for patients with acute cholecystitis who do not improve with antibiotics is urgent cholecystectomy. Acute cholecystitis typically arises from the obstruction of the cystic duct, leading to inflammation of the gallbladder. Although antibiotics are crucial for managing the infection and associated symptoms, they may not be sufficient for resolution in some cases, especially if there is ongoing inflammation or complications such as perforation or abscess formation. Urgent cholecystectomy is recommended when a patient does not show significant improvement with conservative measures, including antibiotics. The timing of the surgery is essential; performing it within 24 to 72 hours of diagnosis has been shown to reduce complications and improve outcomes. In contrast, approaches like discharging the patient with just pain management or switching to oral antibiotics do not address the underlying issue, and simply observing the patient could lead to worsening of the condition and increased risk of surgeries later. Thus, when antibiotics are ineffective, surgical intervention is the most appropriate and effective course of action.