Ratanachu-ek Thawee, Prajanphanit Pitchaya, Leelawat Kawin, Chantawibul Suchart, Panpimanmas Sukij, Subwongcharoen Somboon, Wannaprasert Jerasak
Department of Surgery, Rajavithi Hospital, Rajavithi Rd, Rajathevi, Bangkok 10400, Thailand.
World J Gastroenterol. 2007 Jan 14;13(2):276-9. doi: 10.3748/wjg.v13.i2.276.
To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP).
A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP: 600 cases per year). All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood (in cholangitis) and clinical cholangitis were recorded.
Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n = 26). During ERCP, stones were found in 22 patients, malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis (relative risk = 0.71; 95% CI = 0.14-3.65; P = 0.88). Bacterobilia was found in 27 (56.3%) out of 48 patients. E. coli and Streptococcus viridans were the most common organisms.
Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.
确定环丙沙星在降低经内镜逆行胰胆管造影术（ERCP）后胆汁引流充分的胆汁淤积患者胆管炎发生率方面的作用。
在拉贾维提医院（ERCP三级转诊中心，每年600例病例）对48例胆汁淤积患者进行了一项随机对照试验。所有48例患者在开始任何操作前30分钟接受200毫克环丙沙星静脉注射，然后随机分为两组。研究组的22例患者在ERCP后持续接受环丙沙星治疗直至48小时。记录胆道梗阻的原因、胆汁和血液（胆管炎患者）的细菌学情况以及临床胆管炎情况。
48例患者入组并分为环丙沙星持续治疗组（n = 22）和环丙沙星间断治疗组（n = 26）。在ERCP期间，22例患者发现结石，24例患者发现恶性疾病，5例患者发现其他病理病变。在ERCP后接受环丙沙星治疗的22例患者中有1例（4.5%）发生胆管炎，在ERCP后停用环丙沙星的26例患者中有2例（6.3%）发生胆管炎（相对危险度 = 0.71；95%可信区间 = 0.14 - 3.65；P = 0.88）。48例患者中有27例（56.3%）发现胆汁中有细菌。大肠杆菌和草绿色链球菌是最常见的菌种。
在胆汁引流充分的胆汁淤积患者中持续使用环丙沙星对降低胆管炎发生率无作用。
