PREVENTING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY RELATED SEPSIS - A RANDOMIZED CONTROLLED TRIAL COMPARING 2 ANTIBIOTIC REGIMES

Current antibiotic prophylaxis for endoscopic retrograde cholangiopanc reatography (ERCP) is not standardized and may be inadequate. We aimed to evaluate the efficacy of 3 days of additional oral antibiotics in the prevention of ERCP-related sepsis. One hundred and fifty-six patie nts were randomized prospectively to receive either intravenous ticarc illin and clavulinic acid (Timentin(R); SmithKline Beecham, Dandenong, Victoria, Australia), pre-ERCP (group I) or Timentin(R) and 3 days of oral amoxycillin and clavulinic acid (Augmentin(R); SmithKline Beecha m, Dandenong, Victoria, Australia), group II). Blood cultures were tak en 30 min after the procedure. The occurrence of sepsis, defined as a temperature over 38 degrees C, occurring in the first 7 days was recor ded and the risk factors for the development of sepsis were evaluated. Four patients had significant positive blood cultures despite the pri or administration of Timentin.(R) Sepsis occurred in 10% of group I pa tients, but only 3% of group II patients (relative risk 3.30; 95% conf idence intervals 0.74-14.8). The performance of sphincterotomy and the presence of common bile duct stones were significant risk factors for the development of sepsis. We would recommend 3 days of additional or al Augmentin(R) after a single dose of intravenous antibiotics in pati ents at increased risk of sepsis, which would include those with bile duct stones and/or those undergoing a therapeutic procedure.