Most patients with acute cholecystitis require antibiotics for anti-infective treatment, and the treatment options vary depending on the severity of the condition. Patients with mild acute cholecystitis are usually infected with a single intestinal pathogen, such as Escherichia coli, and can therefore be treated with a single oral antibiotic. The recommended application is oral quinolones, represented by levofloxacin and ciprofloxacin. Oral cephalosporins, representative drugs include cefotiam and cefcapene. First generation cephalosporins, representative drugs include cefazolin. Broad-spectrum penicillin/β-lactamase inhibitors, represented by ampicillin/sulbactam. For patients with moderate acute cholecystitis, broad-spectrum penicillin and second-generation cephalosporins can be used as the patient’s first choice empirically and should also be administered intravenously. Specific drugs are recommended in combination formulations containing β-lactamase inhibitors, such as piperacillin/tazobactam, ampicillin/sulbactam. Second-generation cephalosporins such as cefmetazole, cefotiam, and oxyfluorocephalosporin. One of the above drugs plus metronidazole when anaerobic infection is suspected or confirmed. In patients with severe acute cholecystitis, because they are often multi-drug resistant bacterial infections, broad-spectrum third- and fourth-generation cephalosporins such as cefoperazone/sulbactam, ceftriaxone, ceftazidime, cefazolin are preferred. β-lactams such as aminoglutethimide. When anaerobic infection is suspected or confirmed, one of the above drugs is added to metronidazole. If the preferred agent is ineffective, apply a fluoroquinolone such as ofloxacin, ciprofloxacin, plus metronidazole (when an anaerobic infection or co-infection is present), and carbapenems such as meropenem, imipenem/cilastatin. It is important to note that inappropriate or excessive use of third- and fourth-generation cephalosporins and carbapenems can lead to the emergence of resistant organisms. After selecting the appropriate antibiotic for the patient, the appropriate dose and duration of administration should be established according to its type. After 3-5 days of antibacterial therapy for acute cholecystitis, if the signs and symptoms of acute infection disappear and the temperature and white blood cell count are normal, discontinuation of the drug can be considered.