trimethoprim--sulfamethoxazole-drug-combination and Cholangitis

The aim of this study was to evaluate the efficacy of trimethoprim-sulfamethoxazole (TMP/SMZ) and neomycin as the prophylactic agents against the recurrence of cholangitis in children with biliary atresia (BA) after a Kasai portoenterostomy.. Nineteen BA patients aged 0 to 2 years, who had one episode of cholangitis after a Kasai portoenterostomy, were recruited in this study. Patients were assigned randomly into 2 groups: one (9 cases) with TMP/SMZ (TMP 4 mg/kg/d and SMZ 20 mg/kg/d, divided in 2 doses) and the other (10 cases) with neomycin (25 mg/kg/d, qid, 4 days a week). Another 18 BA patients aged 0 to 2 years, with cholangitis but not put on long-term prophylaxis, served as the historical control group.. The mean prophylactic periods were 14.6 months and 14.7 months in the TMP/SMZ and neomycin groups. Patients who received prophylaxis with either TMP/SMZ or neomycin had lower recurrence rates of cholangitis than those in the control group (P =.042 and.011). There was no difference in the recurrence rates of cholangitis between the TMP/SMZ and neomycin groups (P =.641). The survival rates were higher in the TMP/SMZ and neomycin groups than in the control group (P =.09 and.018).. Use of TMP/SMZ or neomycin is effective as a prophylactic agent against the recurrence of cholangitis after the Kasai portoenterostomy, but there is no difference in efficacy between these 2 regimens.

Topics: Antibiotic Prophylaxis; Biliary Atresia; Child, Preschool; Cholangitis; Drug Therapy, Combination; Female; Humans; Infant; Infant, Newborn; Life Tables; Male; Neomycin; Portoenterostomy, Hepatic; Postoperative Complications; Prospective Studies; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia has emerged as an important cause of morbidity and mortality in hospitalized patients. Because trimethoprim-sulfamethoxazole (TMP-SMX) remains the most effective drug for the treatment of S. maltophilia infections, desensitization should be considered in patients with hypersensitivity to TMP-SMX.

Topics: Bacteremia; Cholangitis; Cross Infection; Desensitization, Immunologic; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

In a 84-year-old woman extraintestinal infection by non-OI Vibrio cholerae was diagnosed. She had septicaemia with cholangitis and cholecysto- and choledocholithiasis. Until now 26 patients with non-OI V. cholerae septicaemia have been reported. Most had an underlying disease, usually a chronic liver disease or haematological malignancy. These disorders were not present in our patient. She was treated with co-trimoxazole and afterwards she underwent a cholecystectomy and common bile duct exploration. At the time of operation no non-OI V. cholerae could be isolated from the gallbladder or the bile from the common bile duct. A possible cause of the infection was a herring which the patient had eaten six weeks before hospital admission.

Topics: Aged; Aged, 80 and over; Cholangitis; Cholelithiasis; Cholera; Female; Gallstones; Humans; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Topics: Biliary Atresia; Child; Cholangitis; Female; Half-Life; Humans; Male; Metabolic Clearance Rate; Portoenterostomy, Hepatic; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

An 8-year-old Arabian gelding with septic cholangitis and peritonitis was successfully treated with trimethoprim/sulfadiazine. The gelding was referred for evaluation of signs of abdominal pain, icterus, fever, and weight loss. Peritoneal fluid analysis revealed septic and suppurative peritonitis. Culture of the peritoneal fluid yielded Escherichia coli and Klebsiella pneumoniae, which were sensitive to trimethoprim/sulfadiazine. On the basis of results of hepatic ultrasonography, a diagnosis of septic cholangitis also was made. The horse was treated with 30 mg of trimethoprim/sulfadiazine/kg, PO, q 12 h for approximately 6 weeks. The horse improved steadily, and telephone follow-up with the owner 1 year later disclosed that the horse had complete return to normal condition, appetite, and attitude. On the basis of our findings, aggressive, long-term anti-inflammatory and antibiotic treatment may result in complete return to health and normal athletic function in horses with septic cholangitis and concurrent septic peritonitis.

Topics: Animals; Cholangitis; Escherichia coli; Escherichia coli Infections; Horse Diseases; Horses; Klebsiella Infections; Klebsiella pneumoniae; Liver; Male; Peritonitis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography