Corticosteroids with moxifloxacin effective against ACC with SLE
Corticosteroids combined with the antibiotic moxifloxacin may be effective for the management of acute acalculous cholecystitis (AAC) with systemic lupus erythematosus (SLE), suggests a new observational study.
The investigators recruited 22 AAC patients with SLE who were receiving conservative management of either moxifloxacin alone (n=10; mean age 36.1±16.3 years) or in combination with corticosteroids (n=12; mean age 34.7±11.0 years). Study outcomes included improvement of symptoms and biochemical results, disease response and surgery.
The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2000) scores were significantly lower in the corticosteroid group than in the antibiotic alone group (7.3±1.4 vs 10.7±3.0; p=0.03). A similar trend was observed with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR) scores (0.1±0.3 vs 0.3±0.5; p=0.01).
The levels of antinuclear antibodies (1.3±0.4 vs 2.1±0.6 IU/mL; p=0.03), antidouble stranded DNA antibodies (40.0±8.3 vs 145.4±25.5 IU/mL; p=0.04) and anticardiolipin antibodies (17.9±4.5 vs 46.8±13.7 IU/mL; p=0.01) were significantly lower in the corticosteroid group than in the antibiotic group.
Significantly more patients in the corticosteroid group showed a positive response (p=0.01) and 11 of 12 patients were treated successfully. Only one patient in the corticosteroid group underwent cholecystectomy after treatment yielded no improvements.
By comparison, only four of 10 patients in the antibiotic alone group were successfully treated, and the remaining six had to undergo cholecystectomy because treatment conferred no improvements.
The rate of successful conservative treatment was thus significantly greater in the corticosteroid group than in the antibiotic group (p=0.02).