Prophylactic Antibiotics for ERCP: Are they Needed?

Endoscopic retrograde cholangio-pancreatography (ERCP) is an invasive procedure associated with potentially significant morbidities including sepsis. Traditionally prophylactic antibiotics have been administered to all patients undergoing ERCP. The most important predictor of sepsis after ERCP is incomplete bile duct drainage. We have adopted a policy of omitting prophylactic antibiotics except where there is a risk of endocarditis or symptomatic bacteraemia and only administer a therapeutic course if an obstructed duct cannot be cleared or drained at ERCP.

Aims and Methods: We reviewed records of all ERCPs performed in our institution from August 1998 to April 2004, with regard to bile duct drainage and subsequent sepsis.

Results: We performed 1775 ERCPs; 733 (41.3%) patients required sphincterotomy or fistulotomy, while 566 (31.9%) required stent insertion. 12 patients (0.7%) received a 24-hour course of intravenous antibiotics because an obstructed bile duct was opacified but not drained. No patient had a septic outcome reported.

Conclusions: The policy of routinely administering antibiotics before all ERCPs is time-consuming, expensive, potentially hazardous and has no proven benefit in our experience and should be reconsidered.