Prophylactic oral antibiotics in prevention of recurrent cholangitis after the Kasai portoenterostomy.
OBJECTIVE
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.
Bu
Ling-Nan
LN
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Chen
Huey-Ling
HL
Chang
Chee-Jen
CJ
Ni
Yen-Hsuan
YH
Hsu
Hong-Yuan
HY
Lai
Hong-Shiee
HS
Hsu
Wen-Ming
WM
Chang
Mei-Hwei
MH
D019072:Antibiotic Prophylaxis; D001656:Biliary Atresia / Q000601:surgery*; D002675:Child, Preschool; D002761:Cholangitis / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009355:Neomycin