We updated the design of this site on September 25th. Learn more.
Show more
ClinicalTrials.gov Menu

Place of Antibiotics in the Postoperative Acute Lithiasic Cholecystitis (ABCAL)

This study has been completed.
ClinicalTrials.gov Identifier:
First Posted: November 18, 2009
Last Update Posted: April 28, 2016
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Centre Hospitalier Universitaire, Amiens

Assess whether postoperative antibiotics after cholecystectomy for acute lithiasic cholecystitis little or moderately severe, is effective and therefore justified.

The main objective is to compare the occurrence of postoperative infectious complications including surgical site infections (SSI) and remote infections after early cholecystectomy (performed within 5 days after onset of symptoms) for acute lithiasic cholecystitis (ALC) little or moderately serious (without organ dysfunction) with and without postoperative antibiotics.

The secondary objectives are:

  • Rates of infectious complications according to duration of preoperative antibiotic
  • Influence of surgical drainage after surgery for occurrence of postoperative infectious complications
  • Analysis of the nature of infectious complications (surgical site infections, remote surgical site infections)
  • Comparison of germs found in the bile during the postoperative infectious complications
  • Duration of hospitalization
  • Readmission rate for surgical site infections
  • Rate of reoperation for surgical site infection
  • Overall mortality rate at 30 days
  • Mortality rates specific to 30 days

Condition Intervention Phase
Acute Lithiasic Cholecystitis Grade I or II Symptoms Lasting for Less Than 5 Days Required Cholecystectomy Preoperative Amoxicillin Clavulanic Acid for at Most 5 Days Drug: Amoxicillin clavulanic acid Other: No medication Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Antibiotic Treatment Versus no Antibiotics in the Postoperative Acute Cholecystitis Low and Moderately Severe

Resource links provided by NLM:

Further study details as provided by Centre Hospitalier Universitaire, Amiens:

Primary Outcome Measures:
  • All complications occurring during hospitalization or within 30 days postoperative. There are 2 main types of postoperative infectious complications: - Surgical site infections (SSI) - Systemic infections - Remote surgical site infections. [ Time Frame: 30 days postoperative ]

Secondary Outcome Measures:
  • Rates of infectious complications according to duration of preoperative antibiotic [ Time Frame: 30 days postoperative ]
  • Influence of surgical drainage after surgery for occurrence of postoperative infectious complications [ Time Frame: 30 days postoperative ]
  • Nature of infectious complications analysis (surgical site infections, infections distance) [ Time Frame: 30 days postoperative ]
  • Comparison of germs found in bile, the germs found in postoperative infectious complications [ Time Frame: since the infectious complication persist ]
  • Duration of hospitalization [ Time Frame: until the release of hospitalization, otherwise at 30 days postoperative ]
  • Readmission rate for surgical site infections (SSI) [ Time Frame: 30 days postoperative ]
  • Rate of reoperation for SSI [ Time Frame: 30 days postoperative ]
  • Overall mortality rate [ Time Frame: 30 days postoperative ]
  • Specific mortality rates [ Time Frame: 30 days postoperative ]

Enrollment: 414
Study Start Date: May 2010
Study Completion Date: November 2012
Primary Completion Date: November 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Amoxicillin clavulanic acid
Postoperative administration of 2g of Augmentin, 3 times daily for 5 days.
Drug: Amoxicillin clavulanic acid
Postoperative administration of 2g, 3 times daily, since 5 days, of amoxicillin clavulanic acid (Augmentin or generic) oral form or parenteral form according to clinical patient and by the choice of medical teams
Other Names:
  • Augmentin
  • generic of amoxicillin clavulanic of any brand name
  • ATC class J01CR02
No medication
no postoperative antibiotics
Other: No medication
no postoperative antibiotics
Other Name: No other name

  Show Detailed Description


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Acute lithiasic cholecystitis low or moderately severe (confined to the gall bladder)
  • Requiring early cholecystectomy (progression of symptoms <5 days
  • In an adult patient (>18 years)
  • For each patient included the consent form must have been read, understood and signed.

Exclusion Criteria:

  • Severe acute cholecystitis (with organ dysfunction)
  • Acalculous cholecystitis
  • Biliary peritonitis
  • Abscess perivesicular
  • Cholangitis
  • Acute Pancreatitis
  • Septic shock
  • Stone of bile duct
  • Physical or mental state does not allow participation in the study
  • Contraindication to surgery
  • Classification ASA (American Society of Anesthesiologists) IV-V or life expectancy <48 hours
  • Suspected pre-or intraoperative cancer of the gallbladder
  • Pregnancy or breastfeeding
  • Treatment course with methotrexate, imidazole
  • Known history of allergy to Augmentin ®
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01015417

Centre de Chirurgie Viscérale et de Transplantation Centre Hospitalier Régional Universitaire
Strasbourg, Alsace, France, 67098
Centre Hospitalier Haut-Lévêque
Bordeaux, Aquitaine, France, 33604
Service de Chirurgie Générale et Digestive. Centre Hospitalier Universitaire
Clermont-Ferrand, Auvergne, France, 63003
Centre Hospitalier Côte e Nacre
Caen, Basse Normandie, France, 14033
Service de Chirurgie Digestive et Vasculaire. Centre Hopsitalier Universitaire
Besançon, Doubs, France, 25030
Service de Chirurgie Digetsive Centre Hopsitalier Universitaire
Montpellier, Hérault, France, 34000
Centre Hospitalier Jean-Verdier
Bondy, Ile de France, France, 93143
Centre Hospitalier Louis Mourier
Colombes, Ile de France, France, 92700
Centre hospitalier Lariboisière
Paris 10, Ile de France, France, 75475
Service de Chirurgie Digestive et Viscérale
Paris, Ile de France, France, 75020
Centre Hospitalier Cochin
Paris, Ile de France, France, 75679
Centre Hospitalier de Saint-Germain en Laye
Poissy, Ile de France, France, 78303
Centre Hospitalier
Longjumeau, Ile de rance, France, 91161
Centre Hospitalier Dupuytren
Limoges, Limousin, France, 87042
Centre Hospitalier C.H.A.M.
Rang du Fliers, Nord pas de Calais, France, 62180
Chirurgie viscérale et urologique Centre Hospitalier
Beauvais, Oise, France, 60021
Centre hospitalier Universitaire
Angers, Pays de la Loire, France, 49933
Service de Chirurgie Viscérale et Digestive
Amiens, Picardie, France, 80054
Centre Hospitalier Timone
Marseille, Province-Alpes Côte d'Azur, France, 13000
Centre Hopitalier Général
Grenoble, Rhône-Alpes, France, 38700
Chirurgie Viscérale et Digestive
Rouen, Seine maritime, France, 76031
Sponsors and Collaborators
Centre Hospitalier Universitaire, Amiens
Study Director: Jean-marc REGIMBEAU, Pr Centre Hospitalier Universitaire, Amiens
Principal Investigator: David FUKS, Dr Centre Hospitalier Universiatire Amiens
  More Information

Kapoor VK, Sikora SS, Bal S. Current practice in biliary surgery: the Indian scenario. Indian J Gastroenterol. 1994 Apr;13(2):49-51.
Kanafani ZA, Khalifé N, Kanj SS, Araj GF, Khalifeh M, Sharara AI. Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence-based guidelines. J Infect. 2005 Aug;51(2):128-34. Epub 2005 Jan 20. Review.
Lewis RT, Allan CM, Goodall RG, Marien B, Park M, Lloyd-Smith W, Wiegand FM. A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery. Can J Surg. 1984 Jan;27(1):44-7.
Lykkegaard Nielsen M, Moesgaard F, Justesen T, Scheibel JH, Lindenberg S. Wound sepsis after elective cholecystectomy. Restriction of prophylactic antibiotics to risk groups. Scand J Gastroenterol. 1981;16(7):937-40.
Landau O, Kott I, Deutsch AA, Stelman E, Reiss R. Multifactorial analysis of septic bile and septic complications in biliary surgery. World J Surg. 1992 Sep-Oct;16(5):962-4; discussion 964-5.
Meijer WS. Antibiotic prophylaxis in biliary tract surgery--current practice in The Netherlands. Neth J Surg. 1990 Aug;42(4):96-100.
Havig O, Hertzberg J. [Effect of ampicillin, chloramphenicol and penicillin + streptomycin in the treatment of acute cholecystitis]. Tidsskr Nor Laegeforen. 1975 Feb 20;95(5):298-300. Norwegian.
Kune GA, Burdon JG. Are antibiotics necessary in acute cholecystitis? Med J Aust. 1975 Oct 18;2(16):627-30.
Groezinger KH. Prophylactic use of mezlocillin in acute cholecystitis. Chemioterapia. 1987 Jun;6(2 Suppl):590.
Muller EL, Pitt HA, Thompson JE Jr, Doty JE, Mann LL, Manchester B. Antibiotics in infections of the biliary tract. Surg Gynecol Obstet. 1987 Oct;165(4):285-92.
Friedlender J, Meyer P, Marti MC, Rohner A. Comparative study of ceftriaxone and cefoperazone in the treatment of acute cholecystitis. Chemotherapy. 1988;34 Suppl 1:30-3.
Lau WY, Yuen WK, Chu KW, Chong KK, Li AK. Systemic antibiotic regimens for acute cholecystitis treated by early cholecystectomy. Aust N Z J Surg. 1990 Jul;60(7):539-43.
Grant MD, Jones RC, Wilson SE, Bombeck CT, Flint LM, Jonasson O, Soroff HS, Stellato TA, Dougherty SH. Single dose cephalosporin prophylaxis in high-risk patients undergoing surgical treatment of the biliary tract. Surg Gynecol Obstet. 1992 May;174(5):347-54.
Krajden S, Yaman M, Fuksa M, Langer JC, Rowan J, Burul CJ, Wooster DL, Deitel M, Borowy ZJ, Smith LC, et al. Piperacillin versus cefazolin given perioperatively to high-risk patients who undergo open cholecystectomy: a double-blind, randomized trial. Can J Surg. 1993 Jun;36(3):245-50.
Chacon JP, Criscuolo PD, Kobata CM, Ferraro JR, Saad SS, Reis C. Prospective randomized comparison of pefloxacin and ampicillin plus gentamicin in the treatment of bacteriologically proven biliary tract infections. J Antimicrob Chemother. 1990 Oct;26 Suppl B:167-72.
Thompson JE Jr, Bennion RS, Roettger R, Lally KP, Hopkins JA, Wilson SE. Cefepime for infections of the biliary tract. Surg Gynecol Obstet. 1993;177 Suppl:30-4; discussion 35-40.
Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, Miura F, Wada K, Hirota M, Yamashita Y, Nagino M, Tsuyuguchi T, Tanaka A, Gomi H, Pitt HA. Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):114-21. Epub 2007 Jan 30.
Eskelinen M, Ikonen J, Lipponen P. Diagnostic approaches in acute cholecystitis; a prospective study of 1333 patients with acute abdominal pain. Theor Surg 1993;8:15-20
Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976 Feb;131(2):219-23.
Telfer S, Fenyö G, Holt PR, de Dombal FT. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol Suppl. 1988;144:47-50.
[Acute abdominal pain. A prospective multicentric study (author's transl)]. Nouv Presse Med. 1981 Dec 19;10(46):3771-3. French.
Bjorvatn B. Cholecystitis--etiology and treatment--microbiological aspects. Scand J Gastroenterol Suppl. 1984;90:65-70.
Tokunaga Y, Nakayama N, Ishikawa Y, Nishitai R, Irie A, Kaganoi J, Ohsumi K, Higo T. Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology. 1997 May-Jun;44(15):671-6.
Bickel A, Rappaport A, Kanievski V, Vaksman I, Haj M, Geron N, Eitan A. Laparoscopic management of acute cholecystitis. Prognostic factors for success. Surg Endosc. 1996 Nov;10(11):1045-9.
Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993 Nov;218(5):630-4.
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparosc Endosc. 1998 Jun;8(3):200-7.
Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, Al-Natour S. Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A. 2002 Jun;12(3):193-8.
Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997 Jun;173(6):513-7.
Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, Joehl RJ. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery. 1999 Oct;126(4):680-5; discussion 685-6.
Bedirli A, Sakrak O, Sözüer EM, Kerek M, Güler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology. 2001 Sep-Oct;48(41):1275-8.
Lahtinen J, Alhava EM, Aukee S. Acute cholecystitis treated by early and delayed surgery. A controlled clinical trial. Scand J Gastroenterol. 1978;13(6):673-8.
Ransohoff DF, Miller GL, Forsythe SB, Hermann RE. Outcome of acute cholecystitis in patients with diabetes mellitus. Ann Intern Med. 1987 Jun;106(6):829-32.
Meyer KA, Capos NJ, Mittelpunkt AI. Personal experinces with 1,261 cases of acute and chronic cholecystitis and cholelithiasis. Surgery. 1967 May;61(5):661-8.
Gagic N, Frey CF, Gaines R. Acute cholecystitis. Surg Gynecol Obstet. 1975 Jun;140(6):868-74.
Girard RM, Morin M. Open cholecystectomy: its morbidity and mortality as a reference standard. Can J Surg. 1993 Feb;36(1):75-80. Review.
Addison NV, Finan PJ. Urgent and early cholecystectomy for acute gallbladder disease. Br J Surg. 1988 Feb;75(2):141-3.
Inoue T, Mishima Y. Postoperative acute cholecystitis: a collective review of 494 cases in Japan. Jpn J Surg. 1988 Jan;18(1):35-42. Review.
Savoca PE, Longo WE, Zucker KA, McMillen MM, Modlin IM. The increasing prevalence of acalculous cholecystitis in outpatients. Results of a 7-year study. Ann Surg. 1990 Apr;211(4):433-7.
Hafif A, Gutman M, Kaplan O, Winkler E, Rozin RR, Skornick Y. The management of acute cholecystitis in elderly patients. Am Surg. 1991 Oct;57(10):648-52.
Glenn F. Surgical management of acute cholecystitis in patients 65 years of age and older. Ann Surg. 1981 Jan;193(1):56-9.
Järvinen HJ, Hästbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980 Apr;191(4):501-5.
van der Linden W, Sunzel H. Early versus delayed operation for acute cholecystitis. A controlled clinical trial. Am J Surg. 1970 Jul;120(1):7-13.
Norrby S, Herlin P, Holmin T, Sjödahl R, Tagesson C. Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg. 1983 Mar;70(3):163-5.
Siddiqui T, MacDonald A, Chong PS, Jenkins JT. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008 Jan;195(1):40-7.
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004 Sep;18(9):1323-7. Epub 2004 Jul 7.
Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998 Jun;85(6):764-7.
Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998 Apr;227(4):461-7.
Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2005 Jan;92(1):44-9.
Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998 Jan 31;351(9099):321-5.
Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997 Jul-Aug;21(6):629-33.
Watson JF. The role of bacterial infection in acute cholecystitis: a prospective clinical study. Mil Med. 1969 Jun;134(6):416-26.
Calpena Rico R, Sánchez Llinares JR, Candela Polo F, Pérez Vázquez MT, Vázquez Rojas JL, Diego Estévez M, Compañ Rosique A, Medrano Heredia J. [Bacteriologic findings as a prognostic factor in the course of acute cholecystitis]. Rev Esp Enferm Apar Dig. 1989 Nov;76(5):465-70. Spanish.
Claesson B, Holmlund D, Mätzsch T. Biliary microflora in acute cholecystitis and the clinical implications. Acta Chir Scand. 1984;150(3):229-37.
Csendes A, Burdiles P, Maluenda F, Diaz JC, Csendes P, Mitru N. Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones. Arch Surg. 1996 Apr;131(4):389-94.
Järvinen HJ. Biliary bacteremia at various stages of acute cholecystitis. Acta Chir Scand. 1980;146(6):427-30.
Linhares MM, Paiva V, Castelo Filho A, Granero LC, Pereira CA, Machado AM, Goldenberg A, Matos D. [Study of preoperative risk factors for bacteriobilia in patients with acute calculosis cholecystitis]. Rev Assoc Med Bras (1992). 2001 Jan-Mar;47(1):70-7. French.
Thompson JE Jr, Bennion RS, Doty JE, Muller EL, Pitt HA. Predictive factors for bactibilia in acute cholecystitis. Arch Surg. 1990 Feb;125(2):261-4.
Pitt HA, Postier RG, Cameron JL. Consequences of preoperative cholangitis and its treatment on the outcome of operation for choledocholithiasis. Surgery. 1983 Sep;94(3):447-52.
Maluenda F, Csendes A, Burdiles P, Diaz J. Bacteriological study of choledochal bile in patients with common bile duct stones, with or without acute suppurative cholangitis. Hepatogastroenterology. 1989 Jun;36(3):132-5.
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15-26. Epub 2007 Jan 30.
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):78-82. Epub 2007 Jan 30.
Martin C. [The use of microbial prophylaxis in visceral surgery. Update 1999]. J Chir (Paris). 1999 Nov;136(4):211-5. French.
Juvonen T, Kiviniemi H, Niemelä O, Kairaluoma MI. Diagnostic accuracy of ultrasonography and C reactive protein concentration in acute cholecystitis: a prospective clinical study. Eur J Surg. 1992 Jun-Jul;158(6-7):365-9.
Håkansson K, Leander P, Ekberg O, Håkansson HO. MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography. Acta Radiol. 2000 Jul;41(4):322-8.
De Vargas Macciucca M, Lanciotti S, De Cicco ML, Coniglio M, Gualdi GF. Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature. Radiol Med. 2006 Mar;111(2):167-80. English, Italian.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. Review.
Weigand K, Köninger J, Encke J, Büchler MW, Stremmel W, Gutt CN. Acute cholecystitis - early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study. Trials. 2007 Oct 4;8:29.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Centre Hospitalier Universitaire, Amiens
ClinicalTrials.gov Identifier: NCT01015417     History of Changes
Other Study ID Numbers: PHRCN09-PR-REGIMBEAU
Eudract N°2009-013470-41 ( Other Identifier: AFSSAPS )
First Submitted: November 17, 2009
First Posted: November 18, 2009
Last Update Posted: April 28, 2016
Last Verified: April 2016

Keywords provided by Centre Hospitalier Universitaire, Amiens:
Acute lithiasic cholecystitis
Postoperative antibiotherapy
Surgical site infection
Remote surgical site infection

Additional relevant MeSH terms:
Acalculous Cholecystitis
Gallbladder Diseases
Biliary Tract Diseases
Digestive System Diseases
Anti-Bacterial Agents
Clavulanic Acids
Clavulanic Acid
Amoxicillin-Potassium Clavulanate Combination
Antibiotics, Antitubercular
Anti-Infective Agents
Antitubercular Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
beta-Lactamase Inhibitors

To Top