All issues > Volume 45(4); 2002

Original Article

J Korean Pediatr Soc. 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 DH Kim¹, Byong Sop BS Lee¹, Yun Kyung YK Kim¹, Jae Sung JS Ko¹, Hoan Jong HJ Lee¹, Jeong Kee JK Seo¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence Yun Kyung YK Kim ,
Jeong Kee JK Seo ,Email: jkseo@plaza.snu.ac.kr

Abstract

Purpose
: 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.
Methods
: 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.
Results
: 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.
Conclusion
: 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.

Keywords :scending cholangitis, Biliary atresia, Cefotaxime, Therapeutic efficacy