Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2020  |  Volume : 25  |  Issue : 3  |  Page : 188-

Choice of prophylactic antibiotic post kasai portoenterostomy

Rajeev Redkar, Vinod Raj 
 Department of Pediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Rajeev Redkar
Department of Pediatric Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra West, Mumbai - 400 050, Maharashtra

How to cite this article:
Redkar R, Raj V. Choice of prophylactic antibiotic post kasai portoenterostomy.J Indian Assoc Pediatr Surg 2020;25:188-188

How to cite this URL:
Redkar R, Raj V. Choice of prophylactic antibiotic post kasai portoenterostomy. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2021 Dec 8 ];25:188-188
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Biliary atresia ranks the foremost condition leading to surgical neonatal cholestasis. Its prompt detection, therefore, forms the crux of management. Although many studies have been published in this genre, the problems haunting surgeons include cholangitis, portal hypertension, and ongoing cirrhosis, among others. The article published in JIAPS Volume 24 Issue 3 by Ramachandran et al. on early cholangitis in biliary atresia post Kasai portoenterostomy was an interesting read.

The incidence of cholangitis in post Kasai portoenterostomy (KPE) children reported in the series is 76% (19/25).[1] The article does not throw light upon preoperative bowel preparation they perform for these children. We have published our results of KPE in the Journal of Indian Paediatrics, and the rate of cholangitis in our series was 20.6% (6/29).[2] We believe in bowel preparation for all the children preoperatively and put them on oral antibiotics (ofloxacin and metrogyl) 5 days before surgery. All the children were maintained on milk and then on clear liquids (sugar water and coconut water) for 1 day before scheduled Operation. We attribute this bowel preparation to lower incidence of cholangitis in jaundice-free children from our series when compared to the published results worldwide between 40% and 93%.[3]

Ramachandran P et al. also mentioned about the prophylaxis they put the children post KPE and use amoxicillin-clavulanic acid and cefpodoxime alternating for 6 months.[1] All our children received trimethoprim + sulphamethaxazole (TMP + SMX) as the antibiotic of choice for prophylaxis.[2] This is in agreement with many of the published articles, highlighting the need for antibiotic prophylaxis post KPE to prevent episodes of cholangitis.[4] We attribute this also to the lower incidence of cholangitis in jaundice-free children post KPE in our series. Currently, because TMP + SMX is unavailable in the market, we have shifted over to cefixime as the choice of antibiotic as it has extensive hepatic metabolism and is excreted primarily in bile.[5] Since this change too, we have not faced a sudden surge in the incidence of cholangitis.

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1Ramachandran P, Safwan M, Balaji MS, Unny AK, Akhtarkhavari A, Tamizhvanan V, et al. Early cholangitis after portoenterostomy in children with biliary atresia. J Indian Assoc Pediatr Surg 2019;24:185-8.
2Redkar R, Karkera PJ, Raj V, Bangar A, Hathiramani V, Krishnan J. Outcome of biliary atresia after Kasai's portoenterostomy: A 15-year experience. Indian Pediatr 2017;54:291-4.
3Luo Y, Zheng S. Current concept about postoperative cholangitis in biliary atresia. World J Pediatr 2008;4:14-9.
4Decharun K, Leys CM, West KW, Finnell SM. Prophylactic antibiotics for prevention of cholangitis in patients with biliary atresia status post-Kasai portoenterostomy: A systematic review. Clin Pediatr (Phila) 2016;55:66-72.
5Mazzei T, Dentico P. The pharmacokinetics of oral cephalosporins. Clin Microbiol Infect 2000;6 Suppl 3:53-4.