GUIDELINES OF THE SOCIETY OF GASTROINTESTINAL ENDOSCOPY (E.S.G.E.)

 

Working group : J.F. Rey (St. Laurent du Var) - A. Budzynska (Katowice) - A. Axon (Leeds) - A. Kruse (Aarhus) - A. Nowak (Katowice)
 

 

ANTIBIOTIC PROPHYLAXIS FOR GASTROINTESTINAL ENDOSCOPY

12/1/98

 

Table 1. Application of antibiotic prophylaxis in gastrointestinal endoscopy.

 

The prevention of:
  • Infective endocarditis
  • Symptomatic bacteraemia
  • Colonisation of orthopaedic and other non-cardiac prostheses
  • Pancreato-biliary sepsis following ERCP
  • Wound infection after endoscopic percutaneous gastrostomy

 

Table 2. Endoscopic procedures associated with higher risk of infectious complications.

 

  • Oesophageal stricture dilation
  • Endoscopic sclerotherapy for oesophageal varices
  • Laser therapy in upper gastrointestinal tract
  • Endoscopic placement of percutaneous feeding tube
  • Endoscopic retrograde cholangiopancreatography for known biliary obstruction or pancreatic pseudocyst

 

Table 3. Conditions associated with a risk of endocarditis or symptomatic bacteraemia.

 

  • High risk:
    • Prosthetic heart valve.
    • Previous endocarditis.
    • Surgically constructed systemic-pulmonary shunt or conduit.
    • Synthetic vascular graft less than 1 year old.
    • Severe neutropenia (neutrophils<1G/l)

  • The moderate, low or theoretical risk with:
    • Mitral valve prolapse with insufficiency.
    • Rheumatic valvular or congenital cardiac lesion.
    • Hypertrophic cardiomyopathy.
    • Ventriculo-peritoneal shunt.
    • Heart transplant.
    • Moderate neutropenia (neutrophils 1-5G/l)

  • And no increased risk with:
    • Mitral valve prolapse without insufficiency.
    • Uncomplicated secundum atrial septal defect.
    • Cardiac pacemaker.
    • Coronary artery bypass graft.
    • Implanted defibrillator.
    • All other patients.

 

Table 4. Recommendations of the antibiotic prophylaxis according to the procedure.

 

procedurepatients risk groupantibiotic prophylaxis
high risk procedures:high risk patientsregimen A or B
oesophageal dilationsevere neutropeniaregimen A or B plus C
variceal sclerosismoderate risk patientsnot necessary
laser therapy in upper GI  regimen A or B

 

  may be considered

low or average risk patients not recommended
low risk procedures:high risk patientsnot necessary

 

 

regimen A or B

 

may be considered

 

moderate or low risk patientsnot recommended
ERCP
  • all patients with:
    biliary occlusion
    pancreatic pseudocyst
    previous cholangitis or
  • therapeutic ERCP
    		• regimen C
    PEGall patientsregimen D

     

    Table 5. Recommended antibiotic regimens

    A. Patients not allergic to penicillin.

    Adults:
    1g amoxycyllin intramuscularly in 2.5ml 1% lignocaine hydrochloride plus 120 mg gentamicin intramuscularly just before start of the procedure, followed by 500 mg amoxycillin orally 6 hours later.

    Children under 10 years:
    500 mg amoxycillin intramuscularly in 2.5ml 1% lignocaine hydrochloride plus 2 mg/kg body weight gentamicin intramuscularly, followed by 250 mg (children 5-9 years) or 125 mg (children 0-4 years) amoxycillin orally 6 hours later.

    B. Patients allergic to penicillin or who have had penicillin more than once in the previous month.

    Adults:
    1g vancomycin in slow intravenous infusion over 100 minutes followed by 120 mg gentamicin intravenously 15 minutes before the procedure
    or 400 mg teicoplanin intravenously followed by 120 mg gentamicin 15 minutes before the procedure

    Children under 10 years:
    20 mg/kg vancomycin by slow intravenous infusion followed by 2 mg/kg gentamicin intravenously
    or 6 mg/kg teicoplanin intravenously followed by 2 mg/kg gentamicin intravenously

    C. Prior to biliary procedures.

    750 mg ciprofloxacin orally 60-90 minutes before the procedure
    or 120 mg gentamicin intravenously just before the procedure
    or a parenteral quinolon, cephalosporin or ureidopenicillin just before the procedure.

    D. Prior to percutaneous endoscopic gastrostomy

    2 g cefotaxime (or equivalent) parenterally 30 minutes before the procedure
    or 4 g piperacillin/0.5 g tazobactam parenterally
    or 1 g amoxycillin/clavulanic acid intravenously

    E. Patients with severe neutropenia

    Adults:
    Add 7.5 mg/kg metronidazole intravenously to any of the above regimens

    Children:
    Add 7.5 mg/kg metronidazole intravenously to any of the above regimens