Background and Study Aims: Considerable controversy exists regarding the role of antibiotic
prophylaxis prior to endoscopic retrograde cholangiopancreatography (ERCP), in that
various studies of antibiotic prophylaxis have reached conflicting conclusions. The
aim of this meta-analysis is to synthesize the data in order to determine whether
antibiotic prophylaxis reduces the rate of occurrence of bacteremia and/or the rate
of sepsis/cholangitis among patients undergoing ERCP.
Patients and Methods: Clinical trials were selected via Medline and Pubmed using subject
words and textwords „ERCP”, „antibiotic” and „antibiotic prophylaxis”. Summary estimates
of the risk ratios for the outcomes of bacteremia and sepsis/cholangitis were calculated.
Results: After 49 abstracts had been reviewed, seven randomized placebo-controlled
trials of antibiotic prophylaxis prior to ERCP were identified. Upon further review,
two studies were excluded because patients received antibiotics before and after the
ERCP. Four studies reported on the clinical outcome of bacteremia. Five studies reported
on the clinical outcome of sepsis/cholangitis. The summary relative risk of the association
between antibiotic prophylaxis and bacteremia was 0.39 (95 % CI, 0.12 - 1.29). For
sepsis/cholangitis the summary relative risk was 0.91 (95 % CI, 0.39 - 2.15).
Conclusions: Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia
but this has little clinical relevance. Prophylaxis does not substantially reduce
the incidence of sepsis/cholangitis and thus the routine use of antibiotic prophylaxis
cannot be recommended.
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A. HarrisM.D.
Division of Hospital Epidemiology
University of Maryland
10 South Pine Street
Room 934
Baltimore, MD 21201-1595
USA
Email: aharris@medicine.umaryland.edu
