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Preventive effect of prophylactic intravenous antibiotics against cholangitis in biliary atresia: a randomized
Gong Chen1, Jia Liu1, YanLei Huang1
1Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
Insights
Short-term prophylactic antibiotics are effective in preventing post-Kasai cholangitis in biliary atresia patients. This approach offers similar protection to longer regimens, simplifying care.
Area of Science:
- Pediatric Surgery
- Hepatology
- Infectious Diseases
Background:
- Biliary atresia (BA) is a critical neonatal liver condition necessitating Kasai portoenterostomy.
- Postoperative cholangitis is a frequent complication following Kasai portoenterostomy, leading to poorer patient outcomes.
- Current antibiotic prophylaxis strategies for post-Kasai cholangitis lack standardization.
Purpose of the Study:
- To evaluate the efficacy of different durations of prophylactic intravenous antibiotics in preventing cholangitis after Kasai portoenterostomy for biliary atresia.
- To compare the incidence, onset, and severity of cholangitis between short-term (7 days) and long-term (14 days) antibiotic regimens.
Main Methods:
- A single-center, randomized clinical trial involving 180 biliary atresia patients undergoing Kasai portoenterostomy.
- Patients were randomized into two groups: short-term (7 days) and long-term (14 days) prophylactic intravenous antibiotic administration.
- Primary outcome: overall cholangitis incidence within 6 months post-surgery. Secondary outcomes included early cholangitis incidence, episodes, jaundice clearance, and native liver survival.
Main Results:
- The overall incidence of cholangitis within 6 months was comparable between the short-term and long-term antibiotic groups (62% vs. 70%, p=0.27).
- No significant differences were observed in jaundice clearance rates or native liver survival between the groups.
- The long-term group showed a significantly lower percentage of early-onset cholangitis (38% vs. 61%, p=0.02) and fewer average episodes (1.8 vs. 2.4, p=0.01).
Conclusions:
- Short-term prophylactic intravenous antibiotic regimens are a viable alternative to long-term administration for preventing post-Kasai cholangitis in biliary atresia.
- While overall incidence is similar, longer antibiotic courses may reduce early-onset cholangitis and the number of episodes.
Objective:
Biliary atresia (BA) is a neonatal liver disease and requires Kasai portoenterostomy. Many patients develop postoperative cholangitis, resulting in a poor prognosis. The preventive strategy of antibiotics is empirical and lacks a standard regimen. We aimed to analyze the effect of different durations of prophylactic intravenous antibiotics against post-Kasai cholangitis.
Study Design:
A single-center, open-labeled, randomized clinical trial was performed from June 2016 to August 2017. One hundred and eighty BA patients were recruited and randomized into a short-term (n = 90) and a long-term (n = 90) treatment group, and prophylactic intravenous antibiotics were used for 7 versus 14 days, respectively. The primary outcome was the overall cholangitis incidence within 6-months post-Kasai portoenterostomy. The secondary outcomes included cholangitis incidence within 1 and 3 months post-Kasai portoenterostomy, the onset and average episodes of cholangitis, jaundice clearance rate, native liver survival rate, and adverse events within 6-months post-Kasai portoenterostomy.
Results:
The cholangitis incidence within 6-months post-Kasai in the short-term group was similar to the long-term group (62% vs. 70%, p = 0.27) with intention-to-treat and pre-protocol analysis. There was no significant difference in jaundice clearance rate or native liver survival rate between the two groups. However, the percentage of early onset (61% vs. 38%, p = 0.02) and average episodes (2.4 ± 0.2 vs. 1.8 ± 0.1 episodes, p = 0.01) of cholangitis were lower in the long-term group.
Conclusion:
Long-term intravenous antibiotics can be replaced by the short-term regimen in the general protection against post-Kasai cholangitis.
