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[Cefotiam excretion into the bile after radical operation of congenital biliary atresia]
Insights
Prophylactic cefotiam (CTM) in infants undergoing biliary atresia surgery effectively reached high bile concentrations, exceeding pathogen minimum inhibitory levels. Successful surgery correlated with better CTM excretion, aiding biliary tract infection prevention.
Area of Science:
- Pediatric Surgery
- Pharmacokinetics
- Infectious Disease
Context:
- Congenital biliary atresia requires complex surgical repair, often involving cholangiojejunostomy.
- Biliary tract infections are a significant post-operative complication.
- Assessing antibiotic efficacy in bile is crucial for preventing surgical site infections.
Purpose:
- To evaluate the biliary excretion and efficacy of prophylactic cefotiam (CTM) in infants after extrahepatic cholangiojejunostomy for biliary atresia.
- To correlate CTM bile levels with surgical outcomes and liver function.
- To determine if CTM concentrations in bile are sufficient to inhibit common biliary pathogens.
Summary:
- Twelve infants received prophylactic cefotiam (50 mg/kg IV) post-cholangiojejunostomy for biliary atresia.
- Higher cefotiam bile concentrations were observed in patients with successful anastomosis, good bile flow, and resolved jaundice.
- Bile cefotiam levels consistently exceeded MIC80 values for key biliary pathogens, demonstrating clinical significance.
Impact:
- Provides evidence for the clinical utility of cefotiam in preventing biliary tract infections in this vulnerable pediatric population.
- Highlights the relationship between surgical success, liver function, and antibiotic pharmacokinetics in the bile.
- Supports the use of cefotiam as an effective prophylactic agent in complex biliary surgeries.
Abstract:
Twelve infants having undergone extrahepatic cholangiojejunostomy (SURUGA'S procedure II) after portal hepaticojejunostomy as a radical operation for congenital biliary atresia received prophylactic cefotiam (CTM) against biliary tract infection, 50 mg/kg by intravenous drip in 1 hour, followed by serial determinations of bile and serum CTM levels. The patients were evaluated as to degree of CTM excretion into the bile, by classification into 4 groups according to success or failure in establishing the anastomosis, bile outflow and persistence of jaundice. Patients with an established anastomosis, satisfactory bile flow and no longer jaundice showed high biliary antibiotic concentrations whereas lower biliary antibiotic levels were seen in those with failure in anastomosis, poor bile flow and persistent jaundice. In both cases, nevertheless, the antibiotic concentration in bile sufficiently exceeded the MIC80 values of CTM against principal bacterial pathogens causative of biliary tract infections, thus demonstrating clinical significance of the use of CTM for this purpose. The antibiotic excretion into the bile improved with normalization of liver function in an infant displaying satisfactory bile outflow from an early postoperative stage. The bile and serum CTM assay data obtained by the agar well method showed a high degree of correlation with those by high performance liquid chromatography.