[Comparison of efficacy between ceftriaxone and cefoperazone plus sulbactam in peri-operative treatment of acute suppurative cholangitis].
OBJECTIVE
To compare the efficacy of ceftriaxone and that of cefoperazone plus sulbactam (sulperazon) in controlling infection, in scavenging bacteria from bile, and in their costs when treating acute suppurative cholangitis with choledochostomy.


METHODS
Patients were randomly assigned to two groups: the ceftriaxone group (R-group, n=95) and sulperazon group (S-group, n=95). Before choledochostomy, both groups received one intravenous dose of the corresponding antibiotics: and 2 g ceftriaxnoe for the R-group, 2 g sulperazon, containing 1 g cefoperazone and 1 g sulbactam, for the S-group. After the operation, the patients in the R-group received ceftriaxone 2 g i.v. q.d.; the patients in the S-group received sulperazon 2 g i.v. b.i.d.. In addition, all patients in both groups received metronidazole 0.5 g daily before and after the operation. The efficacy was evaluated by efficiency in controlling infection and the persisting days of symptoms due to infection, fever and leukocytosis; the persisting days was compared using the life table method to calculate the "cumulative probability of persistence of symptoms (CPPS)". The two groups were also compared in regards to their biliary bacterial clearance rates and the costs directly attributable to the antibiotics.


RESULTS
The efficiency in controlling infection was 98.9% (94/95) in both groups. However, the CPPS of the R-group decreased more rapidly than that of the S-group, Log-Rankchi2=6.7901, P=0.0092. Biliary bacterial clearance rate on post-operative day 3 was 72.0% (36/50) for the R-group, 41.3% (19/46) for the S-group, P=0.0037. Cost directly attributable to the antibiotics were (1788.29 +/- 518.46) yuan (RMB) for the R-group, and (3768.74 +/- 820.55) yuan for the S-group, F=395.51, P=0.0000.


CONCLUSIONS
Both ceftriaxone and sulperazon are effective in treating acute suppurative cholangitis when used before and after choledochostomy. Ceftriaxone is superior in expediting symptom relief and bacterial clearance from bile, and is more cost-effective.
Zhou
Xiao-si
XS
Department of Suegery, Third Hospital of Peking University, Beijing 100083, China.
Zou
Sheng-quan
SQ
Dong
Jia-hong
JH
Wu
Wei-ze
WZ
Zhang
Yang-de
YD
Zhang
Tong-lin
TL
Zeng
Zhong
Z
Li
Nian-feng
NF
Man
Guo-tong
GT
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002438:Cefoperazone / Q000191:economics / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000191:economics / Q000627:therapeutic use*; D002761:Cholangitis / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011184:Postoperative Period; D011446:Prospective Studies; D013407:Sulbactam / Q000191:economics / Q000627:therapeutic use*; D013492:Suppuration / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D002438:Cefoperazone; D013407:Sulbactam