In recent years, nonoperative biliary manipulations have become an important cause of, as well as treatment for, cholangitis. As a result, Charcot's classic triad of symptoms is seen less frequently, and the variety of bacteria causing cholangitis has increased. Newer antibiotics make it possible to avoid the nephrotoxic aminoglycosides. Most patients do not require urgent biliary decompression and should have cholangiography and biliary manipulation only after the sepsis has resolved. However, the 5% to 10% of patients with 'toxic' cholangitis should undergo prompt biliary drainage.
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