Antibiotic Prophylaxis in Endoscopy
Antibiotic prophylaxis in gastrointestinal endoscopy
(2009) Allison MC, Sandoe JAT, Tighe R, Simpson IA, Hall RJ, Elliott TSJ,
Prepared on behalf of the Endoscopy Committee of the British Society of Gastroenterology
The revised BSG guidelines recommending a marked reduction of pre-procedure antibiotic usage are available for download below. The practice of administering antibiotics to prevent endocarditis is no longer recommended. Prophylaxis remains indicated prior to endoscopic gastrostomy/jejunostomy procedures. A selective policy for prophylaxis pre-ERCP is recommended, being indicated for those in whom relief of biliary obstruction is unlikely to be achieved at a single procedure (e.g. dilatation of dominant stricture in multifocal sclerosing cholangitis, or unilateral stenting of cholangiocarcinoma). Prophylaxis is also recommended for patients with severe neutropenia (<0.5x10*9/l) and/or severe immunocompromise from major haematological malignancy who undergo endoscopic procedures with a high risk of bacteraemia (e.g. oesophageal dilatation, variceal sclerotherapy, ERCP in obstructed system).
All endoscopists will be aware of the current controversy and differing guidelines on endocarditis prophylaxis for GI procedures. A working group of the BSG Endoscopy Committee met in March 2006 to revise the 2001 guidance.
NICE has now considered this issue as well. It has come out against the use of antibiotic prophylaxis to prevent endocarditis during gastrointestinal endoscopy. Its guidance on endocarditis prophylaxis was unveiled on 26 March 2008: