Antibiotic prophylaxis appears to reduce risk of infectious complications of ERCP

Antibiotic prophylaxis reduces infectious complications after endoscopic retrograde cholangiopancreatography (ERCP), according to a systematic review and meta-analysis.

Researchers assessed randomized controlled trials published through June 2024 that compared ERCP outcomes with and without antibiotic prophylaxis. Infectious complications included cholangitis, bacteremia, and sepsis; mortality and pancreatitis were also analyzed. A total of 11 randomized controlled trials were included, with 1,086 patients who received antibiotics and 1,019 controls (mean ages, 64.6 and 64.1 years, respectively; 47.4% male). Findings were published by the Journal of Clinical Gastroenterology on Sept 15.

Infectious complications were significantly lower in the antibiotic group (risk difference [RD], −0.08 [95% CI, −0.14 to −0.02]; P=0.00001) compared with controls. Trials showed that beta-lactam and cephalosporin antibiotics had a greater effect on complications than other classes (RD, −0.10 [95% CI, −0.17 to −0.04]; P=0.00001). Bacteremia rates were also reduced in patients taking antibiotics (RD, −0.06 [95% CI, −0.11 to −0.01]; P=0.01), but no differences were seen in cholangitis, sepsis, pancreatitis, or mortality rates between groups.

Limitations include significant heterogeneity among studies, especially regarding classes of antibiotics used and the patient population. The majority of studies were conducted in Europe, one in Israel, and one in Asia.

Although the findings were promising, the study authors noted that antibiotic resistance should be a major concern, and they called for more research on the impact of long-term prophylactic antibiotic use.

However, overall, the findings support the use of “prophylactic antibiotics in all patients undergoing ERCP, regardless of anticipated incomplete drainage or the patient's immune status,” the authors concluded.