PURPOSE: 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.
