Endoscopy Antibiotic Guidelines

1.      Endocarditis

  • For endoscopic procedures, antibiotic prophylaxis should no longer be routinely given in circumstances where the sole aim is the prevention of endocarditis.  Click here for further information.

 

  • Antibiotic prophylaxis is recommended for patients with profound neutropaenia and/or immunosuppression (e.g. advanced haematological malignancy, history of organ transplantation) who undergo procedures that are associated with a high risk of bacteraemia. Procedures associated with high risk of bacteraemia include oesophageal dilatation, variceal injection, laser palliation of cancer, and ERCP in patients with biliary obstruction. 

 

  • If prophylaxis against infective endocarditis is required , the recommended regimen is:- 

- Amoxicillin 1g iv plus Gentamicin 120 mg iv at induction, followed by Amoxicillin 500 mg po 6 hours later.

- For patients allergic to penicillin (see explanatory notes): Teicoplanin (dose dependent on weight - see table) iv plus Gentamicin 120 mg iv stat at induction.

 

Actual body weight

Teicoplanin Dose

<50kg

600mg

50-74kg

800mg

75- 100kg

1000mg

>100kg

1200mg

 

  • If MRSA is suspected then teicoplanin should be included in the antibiotic cover following the dose guidance above.

 

The possibility of infective endocarditis should be considered in patients who develop symptoms and signs of infection during the weeks following an endoscopic procedure.  Such patients should undergo prompt investigation and appropriate treatment. 

2.      ERCP

  • Patients with ongoing cholangitis (or other infections for which therapeutic endoscopy is indicated as part of their management plan) should already have been established on appropriate antimicrobial therapy. See GHNHSFT biliary tree infection antibiotic guidelines for details. If the patient has biliary sepsis and endocarditis risk factors then piperacillin-tazobactam or meropenem should be used for treatment as these agents have enterococcal cover. 

 

  • Routine prophylaxis for ERCP is not necessary in most other circumstances provided that adequate biliary decompression can be achieved

 

  • There are specific circumstances where antibiotic prophylaxis should be given routinely to cover ERCP.  These include:

 

  • Patients at risk of endocarditis
  • Patients with severe neutropaenia and/or haematological malignancy and/or profound immunosuppression (e.g. organ recipient)
  • Patients with biliary disorders, such as primary sclerosing cholangitis or hilar cholangiocarcinoma in whom it can be anticipated that complete biliary drainage will be difficult or impossible to achieve during one procedure
  • Patients with pancreatic pseudocyst.

 

  • When prophylaxis for ERCP is required, the recommended regimen is:- 

- Ciprofloxacin 750 mg po stat 1-2 hours before the procedure or ciprofloxacin 400mg iv stat 1 hour before the procedure

If ciprofloxacin is contraindicated:

- Gentamicin 3mg/kg iv (up to a maximum of 300 mg) stat at induction. Gentamicin ideal body weight / dose table for prophylaxis

 

  • For combined ERCP and  infective endocarditis prophylaxis : 

- Ciprofloxacin 750 mg po stat 1-2 hours before the procedure or ciprofloxacin 400mg iv stat 1 hour before the procedure

plus Amoxicillin 1g iv plus Gentamicin 120 mg iv at induction, followed by Amoxicillin 500 mg po 6 hours later.

For patients allergic to penicillin (see explanatory notes):

- Ciprofloxacin 750 mg po stat 1-2 hours before the procedure or ciprofloxacin 400mg iv stat 1 hour before the procedure

plus Teicoplanin (dose dependent on weight - see table) iv plus Gentamicin 120mg iv stat at induction

 

 

 

Actual body weight

Teicoplanin Dose

<50kg

600mg

50-74kg

800mg

75- 100kg

1000mg

>100kg

1200mg

 

 

  • If MRSA is suspected then teicoplanin should be included in the antibiotic cover following the dose guidance above.

 

3.      PEG

  • Patients having a percutaneous endoscopic gastrostomy (PEG) or jejunostomy (PEJ) should  receive:-

- a single dose of co-amoxiclav 1.2 g iv at induction.

For patients allergic to penicillin:

-  Teicoplanin (dose dependent on weight – see table) iv plus gentamicin 3mg/kg iv (up to a maximum of 300mg) stat at induction.  Gentamicin ideal body weight / dose table for prophylaxis 

 

Actual body weight

Teicoplanin Dose

<50kg

600mg

50-74kg

800mg

75- 100kg

1000mg

>100kg

1200mg

 

  • Patients already receiving broad spectrum antibiotics do not require additional prophylaxis for PEG. 

4.      Variceal Bleeding

Patients with suspected variceal bleeding, or patients with decompensated liver disease who develop acute gastrointestinal bleeding, should have already been established on intravenous antibiotics before undergoing endoscopy as per Trust local guideline

 Last reviewed 20/09/17