Bacterial cholangitis

Bacterial cholangitis in Primary Sclerosing Cholangitis (PSC) is an infection of the bile ducts which requires urgent medical treatment. It can be a medical emergency necessitating prompt antibiotics to prevent sepsis.


Downloadable leaflet* to show to your doctor

*This leaflet, and our PSC overview leaflet, are available free of charge to hospitals. Please contact



What is bacterial cholangitis?

In people with PSC, the immune system ‘attacks’ the bile ducts, causing inflammation, which results in hardening and narrowing of the ducts. This means that the bile cannot drain properly and it builds up in the liver. The normally sterile bile can then become infected. When it is infected it is called bacterial cholangitis. Some people refer to it as a ‘flare up’ or a ‘cholangitis attack’.

Bacterial cholangitis can strike at any time, although it is less common in early disease. It doesn’t mean that your PSC is necessarily progressing; it could just be a ‘blip’. However, it is important for you to be aware of the possible symptoms of a cholangitis attack because it can be a medical emergency necessitating prompt antibiotics to prevent sepsis.


What are the symptoms of bacterial cholangitis?

Cholangitis complicating PSC does not always present with the classic symptoms of a regular infection such as fever, pain, and a high white cell count, and can involve a spectrum of less specific symptoms. This means that doctors inexperienced with PSC at your local A&E department may not recognise your symptoms as being due to cholangitis.

Symptoms can be variable and should not be ignored.

Some PSCers say it feels a bit like having flu and symptoms can include:

  • itching (pruritus)
  • dark urine
  • temperature
  • shivers and chills*
  • fever*
  • abdominal pain in the Right Upper Quadrant (RUQ)
  • jaundice
  • pale stools
  • nausea/vomiting
  • night sweats

*Fever, shivers and chills indicate a serious bacterial infection that needs urgent antibiotic treatment, although not all bacterial infections cause chills. Bacterial cholangitis in PSC may need medical attention even in the absence of fever or chills.


What should I do if I suspect bacterial cholangitis?

If you think you have bacterial cholangitis, urgent medical care is required so you will need to be assessed by A&E, your GP or PSC doctor.


How is bacterial cholangitis treated?

Dr Roger Chapman states that bacterial cholangitis should be:

“Treated with the immediate administration broad-spectrum antibiotics such as ciprofloxacin.”


Left untreated, bacterial cholangitis can cause serious complications such as sepsis.


If you are initially treated for cholangitis at A&E, we recommend that you ensure that your PSC doctor is informed. They will consider your individual circumstances, and in some cases, may also consider an MRI scan or endoscopy to investigate and/or help clear your bile ducts.

It is ideal if patients have a strategy to obtain antibiotics promptly as soon as features of bacterial cholangitis develop, such as a prescription at home.


Bacterial Cholangitis: Top Tips

  • Keep a note of all your symptoms and how long you have had them.
  • Get an urgent appointment with a medical professional.
  • Download and show our leaflet to your doctor.
  • Expect to have an urgent blood test.
  • Expect to be given a broad-spectrum antibiotic such as ciprofloxacin.
  • Contact your usual PSC doctor immediately if you are at all unsure of your treatment or care.


Reviewed Sep 2018


Chapman RW. Primary sclerosing cholangitis. Medicine International. 2015;43(11):648–652.

Hirschfield GM, Karlsen TH, Lindor KD, Adams DH. Primary sclerosing cholangitis. The Lancet. 2013;382(9904):1587-1599.

Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis–a comprehensive review. Journal of hepatology. 2017 Aug 10.


Bacterial Cholangitis Leaflet

Special thanks to our reviewers for this information:

Specialist reviewers: Dr Roger W. Chapman, Dr Kate Lynch (née Williamson)

Patient reviewers: Maxine Cowlin, Teresa Wilcox

Reviewed: Sep 2018

Next review: March 2019

Copies available for hospitals - please email

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