Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. A survey of South African endoscopists and review of the literature.

BACKGROUND

Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among South African endoscopists who perform ERCPs, and then reviewed international guidelines and relevant studies.

METHODS

Our audit of South African endoscopists who perform ERCPs took the form of a questionnaire. For the literature review a Pubmed search was performed from 1978 to March 2008, and these findings were compared with the current practice in South Africa.

RESULTS

No specific protocols were being implemented widely in South Africa, and there was a marked difference in the practice between surgical and medical gastroenterologists, with surgeons using antibiotics more often. There was also a wide spectrum of antibiotic types that were being used. The Pubmed search revealed only 7 randomised controlled trials, with little consensus between them as to the absolute indications for prophylactic antibiotics in ERCP.

CONCLUSIONS

Guidelines on antibiotic prophylaxis for ERCP are based on poor evidence. Varied opinions on its indications in South Africa may reflect the situation in other countries as well.