Effective antibiotic regime for postoperative acute cholangitis in biliary atresia--an evolving scene.
OBJECTIVE
The prompt use of empirical antibiotics is vital in managing post-Kasai cholangitis. The authors published findings of their clinical trial in 1991 and established the use of cefoperazone, with a response rate of 88.9%. Here its clinical use since its introduction is reviewed and the trend in its efficacy is assessed.


METHODS
A retrospective review was carried out between 1997 and 2003. All episodes of acute cholangitis in patients who underwent Kasai procedure were recorded. Cholangitis was defined as unexplained fever with derangement of liver enzymes. Cefoperazone was started empirically according to the established protocol, and the response to treatment was analyzed.


RESULTS
There were 19 patients with a total of 49 episodes of cholangitis. Cefoperazone was used as the first-line empirical antibiotic in 40 of these episodes. Only 30 showed successful response (75%). For the 10 unresponsive episodes, meropenem was used as second-line antibiotic with complete response in all.


CONCLUSIONS
The efficacy of cefoperazone in the treatment of post-Kasai cholangitis has decreased over the last years. This suggests a need for a more effective first-line empirical antibiotic. From this review, meropenem seems to be a suitable candidate, and a future prospective clinical trial is warranted.
Wong
Kenneth K Y
KK
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
Fan
Alex H
AH
Lan
Lawrence C L
LC
Lin
Steve C L
SC
Tam
Paul K H
PK
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001656:Biliary Atresia / Q000601:surgery*; D002438:Cefoperazone / Q000627:therapeutic use*; D002648:Child; D002761:Cholangitis / Q000188:drug therapy*; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002438:Cefoperazone