Who should receive antibiotic prophylaxis before ERCP?

Abstract

Infectious complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare but can be major. The role of antibiotic prophylaxis in this setting is not clear and clinical practice varies widely. In this Practice Point commentary, I discuss the findings and limitations of a study by Cotton and colleagues, which investigated a sequential quality improvement approach over 11 years for antibiotic prophylaxis of infection after ERCP. The authors made several changes in practice over the study period leading to a dramatic reduction in use of antibiotics. In the final phase, antibiotics were given only to 26% of patients, but this group probably represents those patients who really benefit from prophylaxis. The study by Cotton et al. underlines that the findings of randomized, controlled trials should be adopted in practice, but that findings should be critically analyzed with selective changes in practice taken over time on the basis of clever analysis of clinical studies and local practice.