On-line version ISSN 2078-5151
Print version ISSN 0038-2361
S. Afr. j. surg. vol.47 n.1 Cape Town Feb. 2009
Martin BrandI; Damon BizosII
IM.B. CH.B., M.R.C.S; Department of Surgery, University of the Witwatersrand, Johannesburg
IIM.B. B.CH., F.C.S. (S.A.); Department of Surgery, University of the Witwatersrand, Johannesburg
BACKGROUND: Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among South African endoscopists who perform ERCPs, and then reviewed international guidelines and relevant studies.
METHODS: Our audit of South African endoscopists who perform ERCPs took the form of a questionnaire. For the literature review a Pubmed search was performed from 1978 to March 2008, and these findings were compared with the current practice in South Africa.
RESULTS: No specific protocols were being implemented widely in South Africa, and there was a marked difference in the practice between surgical and medical gastroenterologists, with surgeons using antibiotics more often. There was also a wide spectrum of antibiotic types that were being used.
The Pubmed search revealed only 7 randomised controlled trials, with little consensus between them as to the absolute indications for prophylactic antibiotics in ERCP.
CONCLUSIONS: Guidelines on antibiotic prophylaxis for ERCP are based on poor evidence. Varied opinions on its indications in South Africa may reflect the situation in other countries as well.
“Full text available only in PDF format”
1. Romagnuolo J, Cotton PB, Mauldin P, Hawes RH, Lawrence C, Payne KM. Changing trends in ERCP practice over a decade. Gastrointest Endosc 2005; 61: AB155. [ Links ]
2. Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP. Gas-trointest Endosc 2003; 57: 633-638. [ Links ]
3. Harris A, Chan AC, Torres-Vierra C, Hammett R, Carr-Locke D. Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1999; 31: 718-724. [ Links ]
4. Llach J, Bordas JM, Almela M, et al. Prospective assessment of the role of antibiotic prophylaxis in ERCP. Hepatogastroenterology 2006; 53: 540-542. [ Links ]
5. Lorenz R, Lehn N, Born P, Herrmann M, Neuhaus H. [Antibiotic prophylaxis using cefuroxime in bile duct endoscopy]. Dtsch MedWochenschr 1996; 121: 223-230. [ Links ]
6. Sauter G, Grabein B, Huber G, Mannes GA, Ruckdeschel G, Sauerbruch T. Antibiotic prophylaxis of infectious complications with endoscopic retrograde cholangiopancreatography. A randomized controlled study. Endoscopy 1990; 22: 164-167. [ Links ]
7. van den Hazel SJ, Speelman P, Dankert J, Huibregtse K, Tytgat GN, van Leeuwen DJ. Piperacillin to prevent cholangitis after endoscopic retrograde cholangiopancreatography. A randomized, controlled trial. Ann Intern Med 1996; 125: 442-447. [ Links ]
8. Byl B, Deviere J, Struelens MJ, et al. Antibiotic prophylaxis for infectious complications after therapeutic endoscopic retrograde cholangiopancreatography: a randomized, double-blind, placebo-controlled study. Clin Infect Dis 1995; 20: 1236-1240. [ Links ]
9. Raty S, Sand J, Pulkkinen M, Matikainen M, Nordback I. Post-ERCP pancreatitis: reduction by routine antibiotics. J Gastrointest Surg 2001; 5: 339-345; discussion 345. [ Links ]
10. Niederau C, Pohlmann U, Lubke H, Thomas L. Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized controlled clinical study. Gastrointest Endosc 1994; 40: 533-537. [ Links ]
11. Lygidakis NJ. The significance of biliary pressure in acute cholangitis. Surg Gynaecol Obstet 1985; 161: 465. [ Links ]
12. Somberg KA. Complication of gallstone disease. In: Berk JE, ed. Gastroen-terology. Philadelphia: WB Saunders, 1985: 1805-1826. [ Links ]
13. Cotton PB, Connor P, Rawls E, Romagnuolo J. Infection after ERCP, and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years. Gastrointest Endosc 2008; 67: 471-475. [ Links ]
14. Vennes JA. Infectious complications of gastrointestinal endoscopy. Dig Dis Sci 1981; 60-64. [ Links ]
15. Martin TR. The reduction of septic complications following ERCP in obstructed patients. Gastrointest Endosc 1979; 25: 43. [ Links ]
16. Fraser TG, Reiner S, Malczynski M, Yarnold PR, Warren J, Noskin GA. Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak. Infect Control Hosp Epidemiol 2004; 25: 856-859. [ Links ]
17. Classen DC, Jacobson JA, Burke JP, Jacobson JT, Evans RS. Serious Pseu-domonas infections associated with endoscopic retrograde cholangiopancreatography. Am J Med 1988; 84: 590-596. [ Links ]
18. Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendation by the American Heart Association. Circulation 1997; 96: 358-366. [ Links ]
19. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 2008; 139: Suppl, 3S-24S. [ Links ]
20. Malone JM, Moore WS, Campagna G, Bean B. Bacteremic infectability of vascular grafts: the influence of pseudointimal integrity and duration of graft function. Surgery 1975; 78: 211-216. [ Links ]
21. American Society of Gastro-Enterology. Guidelines for antibiotic prophylaxis for GI endoscopy. GastrointestEndoscop 2003; 58: 475-482. [ Links ]