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The following is a summary of “Randomized Trial of Prophylactic Antibiotics for Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Obstruction,” published in the January 2024 issue of Gastroenterology by Leem, et al.

Postendoscopic retrograde cholangiopancreatography (ERCP) infections occur in up to 18% of patients with biliary obstruction. While antibiotic prophylaxis may mitigate infectious complications after ERCP, its clinical efficacy remains contentious.

A double-blind, placebo-controlled, randomized trial was conducted to assess whether prophylactic antibiotics reduced infectious complications post-ERCP in patients with biliary obstruction. Patients were randomly assigned in a 1:1 ratio to receive either a single dose of 1 g intravenous cefoxitin or normal saline as a placebo 30 minutes before ERCP. The primary outcome measured was the incidence of infectious complications post-ERCP.

The trial enrolled 378 patients, with 189 patients in each group. The risk of infectious complications post-ERCP was 2.8% (5 of 176 patients) in the antibiotic prophylaxis group and 9.8% (17 of 173 patients) in the placebo group (risk ratio, 0.29; 95% CI, 0.11–0.74, P = 0.0073). Bacteremia incidence rates were 2.3% (4 of 176 patients) and 6.4% (11 of 173 patients), respectively (risk ratio, 0.36; 95% CI, 0.12–1.04; P = 0.0599). Cholangitis incidence rates were 1.7% (3 of 176 patients) in the antibiotic prophylaxis group and 6.4% (11 of 173 patients) in the placebo group (risk ratio, 0.27; 95% CI, 0.08–0.87; P = 0.0267).

Antibiotic prophylaxis before ERCP in patients with biliary obstruction significantly reduced the risk of infectious complications, particularly cholangitis, compared to placebo.

Reference: journals.lww.com/ajg/fulltext/2024/01000/randomized_trial_of_prophylactic_antibiotics_for.26.aspx