Are Enteral Antibiotics as Effective as Intravenous Antibiotics in Preventing Post PEG Infections? A Randomized Prospective Study

Abstract

Purpose: Patients undergoing PEG placement are often predisposed to infection because of age, compromised nutritional status, immune-suppression and underlying diseases such as malignancy and diabetes. Wound infection at the gastrostomy site is one of the most common complications of PEG placement. Its incidence is reported to be between 4.3% and 16% and another 3-8% of patients may develop local cellulites or abscess formation. Currently, the standard of care involves intravenous infusion of antibiotics at the time of PEG placement and 1-2 subsequent doses. However, the use of PEG delivered antibiotics has not been studied as an alternative choice. Methods: In this randomized control trial, we studied 36 patients undergoing new PEG tube placement. Informed consent was obtained from the health care proxy of these patients before enrollment in the research protocol. Patients were randomized to receive either standard dose of intravenous antibiotics (Cefazolin 1 gram IV during the procedure and 8 hours later, n=16) or via PEG (Cephalexin 1 gram via PEG after the procedure and 8 hours later, n= 18). Patients were generally discharged once they tolerated PEG feeds (within 30 hours of PEG placement). Patients with allergy to above antibiotics, concurrent infection, AIDS, on hemodialysis, leukocytosis, on systemic antibiotics, chemotherapy or systemic steroids were excluded. Post procedure patients were followed for 10 days to determine development of infection at PEG site or systemic infection. Results: 10-day post procedure follow-up showed that there was no wound infection, cellulitis, abscess formation or development of systemic infection in either group. Use of intravenous or enteral antibiotics was not associated with any adverse events. Conclusion: In this limited study, enteral antibiotics were as effective as intravenous antibiotics for the prevention of post PEG infections. Enteral antibiotics are well tolerated and are cost-effective (Cefazolin IV 1 Gm.* 2 doses=$6.74 vs. Cephalexin PO 1 Gm.* 2 doses= $0.48) and seem to be an equally effective alternative to intravenous antibiotics. The use of PEG delivered antibiotics is useful for patients undergoing outpatient PEG procedures and eliminates the need for a hospital stay to receive subsequent antibiotic doses. The enteral route will eliminate intravenous line associated complications such as local infiltration and thrombophlebitis. The study will be continued to assess if enteral antibiotics could be routinely used following PEG tube placement as a cost effective and convenient method to prevent local infections.