Acute cholangitis (AC) in children is a rare but life-threatening infection. Symptoms vary from mild to severe disease. There are no local published data on pediatric AC.
Objective: To determine the clinical, biochemical, ultrasonographic, microbiologic features, and treatment outcome of consecutive pediatric patients with definite AC.
Methods: Retrospective study using medical records of pediatric patients diagnosed with definite AC based on the Modified Tokyo Guidelines 2018 admitted from January 2016 to June 2021.
Results: Twenty-seven patients were included. Ages ranged from 0 to 18 years old, predominantly males (51.85%). Choledocholithiasis (22%) and post-Kasai biliary atresia (22%) were mostly the underlying biliary conditions. Fever (88.89%) was the most common presenting symptom. Majority were classified as moderate AC (40.74%). Leukocytosis, elevated inflammatory markers, serum bilirubin and alanine transferases were noted. Majority (87%) have culture-negative results in blood while 50% of bile culture isolates was Klebsiella pneumoniae. Dilated biliary ducts on abdominal ultrasound was observed in 92.59% patients. Most common initial antibiotic was Ampicillin-Sulbactam (29.63%). Discharge rate was high (88.89%).
Conclusion: AC affected all pediatric ages but clinical presentations vary. Klebsiella pneumoniae from bile culture was resistant to empiric antibiotics used but did not affect treatment success.  Generally, pediatric AC has a favorable outcome.

Arianne L. Calimlim-Samson is a pediatrician who had her further training in pediatric infectious disease at the Philippine General Hospital from 2020-2021. Currently, she is an active consultant at various hospitals in her hometown, Dagupan City, Philippines, where she shares her expertise in general pediatrics as well as infectious disease.