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Therapeutic Efficacy of Cefotaxime as an Empirical Antibiotic on Ascending Cholangitis after Kasai Operation for Biliary Atresia

Journal of the Korean Pediatric Society 2002;45(4):474-481.
Published online April 15, 2002.
Therapeutic Efficacy of Cefotaxime as an Empirical Antibiotic on Ascending Cholangitis after Kasai Operation for Biliary Atresia
Dong Ho Kim, Byong Sop Lee, Yun Kyung Kim, Jae Sung Ko, Hoan Jong Lee, Jeong Kee Seo
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
Kasai 수술 후 발생한 상행성 담관염에서 경험적항생제로서 Cefotaxime 치료의 적정성에 대한 평가
김동호, 이병섭, 김윤경, 고재성, 이환종, 서정기
서울대학교 의과대학 소아과학교실
Yun Kyung Kim, 
Jeong Kee Seo, Email: jkseo@plaza.snu.ac.kr
: Ascending cholangitis is the most common complication after Kasai operations. The aim of this study is to evaluate the therapeutic efficacy of cefotaxime as an empirical antibiotic on ascending cholangitis after Kasai operations.
: Thirty-nine episodes of cholangitis in twenty-nine children who underwent Kasai operations at Seoul National University Children's Hospital from January 1991 to December 2000 were included in this study. Empirical cefotaxime treatments were divided into three groups : cefotaxime and amikacin treatment group(CA group), cefotaxime and gentamicin treatment group(CG group) and cefotaxime treatment group(C group). A diagnosis of cholangitis was made on the basis of unexplained fever(>38℃) and either development of acholic stool or elevation of serum total bilirubin (>1.5 mg/dL). Therapeutic efficacy was judged by elimination of fever up to 72 hours, 120 hours, and 168 hours after antibiotic treatment.
: There were therapeutic responses in 51%(20/39) up to 72 hours after antibiotic treatment : 54%(13/24) in CA group, 43%(3/7) in CG group and 50%(4/8) in C group. There were therapeutic responses in 69%(27/39) up to 120 hours, in 79%(31/39) up to 168 hours and in 82%(32/ 39) up to 2 weeks. There were no differences in therapeutic efficacy among the three regimens. In 12 of 39 episodes, the etiologic pathogens including Escherichia coli and enterococcus were cultured from the blood.
: Cefotaxime can be tried as an initial antibiotic in Korean children with ascending cholangitis after Kasai operation prior to the identification of microorganism on culture. However, further evaluation of pathogen and its resistant strain to cefotaxime should be done.
Key Words: scending cholangitis, Biliary atresia, Cefotaxime, Therapeutic efficacy

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