Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: Results of a randomized controlled clinical study

Niederau, Claus; Pohlmann, Ulrike; Lübke, Heinrich J.; Thomas, Lutz

doi:10.1016/s0016-5107(94)70247-0

Cited by 83 publications

(34 citation statements)

References 20 publications

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“…In our study, cholangitis incidence after ERCP was lower than that in previous studies [8,9,15] . This might be attributed to the low natural incidence of the disease [4] , standard sterile technique used in our hospital, and all procedures done by the same endoscopist, and our technique in collecting the bile before injecting contrast media.…”

Section: Discussioncontrasting

confidence: 82%

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

Ratanachu‐ek

Prajanphanit²,

Leelawat³

et al. 2007

WJG

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AIM: To d e t e r m i n e t h e r o l e o f c i p r o f l o x a c i n i n reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP). METHODS:A ra n d o m i z e d , c o n t r o l l e d t r i a l w a s 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. RESULTS: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. CONCLUSION:

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Section: Discussioncontrasting

confidence: 82%

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

Ratanachu‐ek

Prajanphanit²,

Leelawat³

et al. 2007

WJG

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“…Piperacillin proved to be superior to placebo, 52 as did cefotaxime. 53 However, in a large prospective randomized trial involving 551 patients, those who received piperacillin 4 g 30 min before ERCP did not have a lower incidence of cholangitis (4.4%) compared with a placebo group (6.0%). 54 This study questions the routine use of prophylactic antibiotics for ERCP and emphasizes the need for immediate and adequate biliary decompression to prevent life-threatening cholangitis in patients with malignant biliary obstruction.…”

Section: Treatment Failures and Preventionmentioning

confidence: 94%

Management of cholangitis

Bornman

Beljon

2003

Journal of Hepato-Biliary-Pancreatic Surgery

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Acute cholangitis remains a life-threatening complication of biliary obstruction, particularly in the elderly with comorbid disease or when there is a delay in diagnosis and treatment. The initial management consists of fluid resuscitation, correction of coagulopathy, and administration of broad-spectrum antibiotics. The choice of antibiotics should cover both gram-negative and gram-positive organisms associated with cholangitis until the results of a blood culture are available. The timing and choice of biliary decompression varies depending on the response to antibiotic therapy, the presence of comorbid disease, and the underlying cause. Biliary sepsis resolves in most patients with conservative treatment, thus allowing time to perform more detailed non-interventional imaging (e.g., spiral computed tomography [CT], magnetic resonance cholangiopancreatography [MRCP]) to determine the underlying cause and level of biliary obstruction. Those with cholangitis who do not respond to conservative therapy will require urgent biliary decompression. In patients with choledocholithiasis, endoscopic drainage is now the treatment of choice or, if this fails, transhepatic biliary decompression is a useful alternative. Various endoscopic options are available for managing choledocholithiasis, ranging from endoscopic papillotomy (EP) and extraction of stones, to the placement of a biliary drainage system. In patients who respond to antibiotic therapy, EP with stone extraction is preferred, while in those with ongoing sepsis and multiple large stones, the placement of a stent with or without an EP is the safest option. Transhepatic biliary drainage is now reserved for failure of endoscopic drainage and for patients with suspected hilar cholangiocarcinoma or intrahepatic stones. Surgical biliary decompression is seldom required in the emergency setting, but still plays an important role in the definitive treatment of the underlying cause.

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“…A routine endoscopic balloon dilatation should be considered as a valid alternative to ES in selected patients with small and few common bile duct calculi and a high risk of bleeding after ERCP, although it carries a high incidence of post-procedural pancreatitis [149] (LE1). In such cases, no routine drug prophylaxis of pancreatitis is recommended in patients undergoing ERCP [150] (LE2). The use of prophylactic antibiotics before ERCP is recommended especially in patients with biliary obstruction [151] (LE1).…”

Section: Acute Cholecystitismentioning

confidence: 99%