Prophylactic oral antibiotics in prevention of recurrent cholangitis after the Kasai portoenterostomy.

Abstract

PURPOSE:

The aim of this study was to evaluate the efficacy of trimethoprim-sulfamethoxazole (TMP/SMZ) and neomycin as the prophylactic agents against the recurrence of cholangitis in children with biliary atresia (BA) after a Kasai portoenterostomy.

METHODS:

Nineteen BA patients aged 0 to 2 years, who had one episode of cholangitis after a Kasai portoenterostomy, were recruited in this study. Patients were assigned randomly into 2 groups: one (9 cases) with TMP/SMZ (TMP 4 mg/kg/d and SMZ 20 mg/kg/d, divided in 2 doses) and the other (10 cases) with neomycin (25 mg/kg/d, qid, 4 days a week). Another 18 BA patients aged 0 to 2 years, with cholangitis but not put on long-term prophylaxis, served as the historical control group.

RESULTS:

The mean prophylactic periods were 14.6 months and 14.7 months in the TMP/SMZ and neomycin groups. Patients who received prophylaxis with either TMP/SMZ or neomycin had lower recurrence rates of cholangitis than those in the control group (P =.042 and.011). There was no difference in the recurrence rates of cholangitis between the TMP/SMZ and neomycin groups (P =.641). The survival rates were higher in the TMP/SMZ and neomycin groups than in the control group (P =.09 and.018).

CONCLUSIONS:

Use of TMP/SMZ or neomycin is effective as a prophylactic agent against the recurrence of cholangitis after the Kasai portoenterostomy, but there is no difference in efficacy between these 2 regimens.

• Authors: Ling-Nan Bu, Huey-Ling Chen, Chee-Jen Chang, Yen-Hsuan Ni, Hong-Yuan Hsu, Hong-Shiee Lai, Wen-Ming Hsu, Mei-Hwei Chang
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 38 Issue 4 Pg. 590-3 (Apr 2003) ISSN: 1531-5037 [Electronic] United States
• PMID: 12677572 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2003, Elsevier Science (USA). All rights reserved.

Chemical References

• Trimethoprim, Sulfamethoxazole Drug Combination
• Neomycin

Topics

• Antibiotic Prophylaxis
• Biliary Atresia (surgery)
• Child, Preschool
• Cholangitis (prevention & control)
• Drug Therapy, Combination (administration & dosage, therapeutic use)
• Female
• Humans
• Infant
• Infant, Newborn
• Life Tables
• Male
• Neomycin (administration & dosage, therapeutic use)
• Portoenterostomy, Hepatic
• Postoperative Complications (prevention & control)
• Prospective Studies
• Recurrence
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage, therapeutic use)