Antibiotics are not generally indicated for cholecystitis unless evidence of complications such as emphysematous or gangrenous cholecystitis or perforation.
In the presence of suspected gangrene or perforation, immediate surgery is indicated and initiate empiric antimicrobial therapy.
If cholecystectomy is performed, antimicrobials can be safely discontinued 24 hours following surgery, if no intra-operative complications.
Ceftriaxone 1g IV q24h
Metronidazole 500mg PO/IV q12h
Amoxicillin-clavulanate 875mg PO BID