Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.1.6 ERCP.
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Bai
2009
[1]
China
Metaanalysis
7 studies including
1 389 patients. ERCP
I: Cefuroxime 1 g, 1.5 g or 2.0 g.
2 g iv 15 min, 30 min or 1 h before
ERCP. Piperacillin 4 g iv 30 min
before ERCP. Clindamycin 60 mg
and gentamicin 80 mg im 1 h before
ERCP
C: No ab
or placebo
Post ERCP cholangitis
or sepsis
I: 23/684 (3.5%)
C: 41/705 (5.8%)
RR 0.58, (95% CI
0.22–1.55)
Studies with only
suspected biliary
obstruction
I: 12/425 (2.8%)
C: 24/441 (5.4%)
RR 0.33 (95% CI 0.03–
3.32) non-significant
Not stated
Moderate
Ab should not be routinely
used. Studies may be underpowered
to detect benefit
of prophylaxis. Only one
study includes patients
with suspected obstruction,
but this was also negative.
Antibiotics is not justified
for unselected patients
with incomplete drainage
or immunosuppression
may need prophylaxis
Davis
1998
[40]
United
Kingdom
RCT
Two ab in high-risk
patients and ERCP
(obstruction).
Power calculation.
n=150
Follow-up 7 days
I1: Ciprofloxacin 750 mg oral
12-hourly (n=77)
I2: Cephazolin 1 g iv 12 hourly
90 min before ERCP and
continued for 3 days (n=72)
Sepsis/cholangitis
I1: 0 sepsis or
cholangitis/sepsis
I2: 3 pts with
cholangitis/sepsis
0 Moderate
Oral ciprofloxacin
significantly better
Harris
1999
[67]
USA
Metaanalysis
7 studies 1 235 pts.
RCT of ab prophylaxis
in ERCP, oral
or iv
Cefotaxime 2 g iv 15 min before
ERCP.
Cefonicid 1 g iv 1 h before ERCP.
Cefuroxime 1.5 g iv 30 min before
ERCP.
Piperacillin 4 g iv 30 min before
ERCP.
Minocycline 300 mg orally
Placebo
or no intervention
Bacteremia
RR 0.39 (95% CI
0.12–1.29)
Cholangitis/sepsis
RR 0.91 (95% CI
0.39–2.15)
High
Not significant. One study
positive, but they gave ab
for 7 days after ERCP.
Recommendation for
use of ab high risk –
endocarditis – biliary
obstruction – pseudocysts
ab = Antibiotics; C = Control group; CI = Confidence interval; ERCP = Endoscopic
retrograde cholangiopancreatography; I = Intervention group; iv = Intravenous;
n = Number of patients; RCT = Randomised controlled trial; RR = Relative risk
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