ANTIBIOTIC-PROPHYLAXIS WITH CEFUROXIM IN THERAPEUTIC ENDOSCOPY OF THEBILE-DUCTS

Objective: To assess prospectively the effectiveness of a single proph ylactic dose of cefuroxim before therapeutic endoscopy, in view of the general practice not to give antibiotics routinely. Patients and meth ods: In a prospective study endoscopic retrograde cholangiopancreatogr aphy (ERCP) or percutaneous transhepatic cholangiography with drainage (PTCD) together with simultaneous stone extraction, dilatation or ste nt implantation were performed in 99 patients (51 men, 48 women; mean age 60.6 +/- 19.2 years). Group A (n = 49) received 1500 mg cefuroxim i.e. 30 min before the procedure, while none was given to group A pati ents (n = 50). Several blood cultures were taken up to 60 min after th e endoscopy. The number of septicaemias (bacteraemia with fever, rigor , circulatory reactions, leukocytosis or leukopenia) were noted. Bile cultures were obtained in 56 patients with indwelling biliary drainage . Results: Incidence of bacteraemia was 6.1 % (3 of 49) in group A, 16 % (8 of 50) in group B, but this difference is not statistically signi ficant. The septicaemia rate was 6.1% in group A and 10% in group B (n ot significant). There were eleven positive blood cultures with 12 dif ferent microorganisms, Escherichia coli in four (A: n = 3). In vitro c efuroxim sensitivity was 53.3%. 25 different bacterial species were is olated from 73,2% of bile cultures, of which 53.4% were sensitive to c efuroxim and 8.2% moderately so. Conclusion: Although the obtained dif ferences between the two groups were not statistically different, the reduction in bacteraemia/septicaemia Fate may be of clinical use. Furt her studies are needed with higher dosages or antibiotic combinations to improve these results.