Intravenous Antibiotics Impact on Post-ERCP Pancreatitis

Abstract

Introduction: In a previous report, antibiotic prophylaxis of intravenous ceftazidime given 30 minutes before ERCP decreased the risk of pancreatitis, suggesting that bacteria could play a role in the pathogenesis of post-ERCP pancreatitis (PEP). We aimed to evaluate the role of antibiotics on the incidence of PEP. Methods: A single-center, retrospective, case-control study was conducted to evaluate the potential effect of pre-ERCP intravenous antibiotics (piperacillin and tazobactam, ciprofloxacin and cefoxitin) in preventing PEP. All patients who underwent ERCP between January 2007 and February 2014 were included. Medical records of the patients were reviewed for demographic information, history of systemic disease, smoking, and alcohol abuse. Physician orders and nursing notes were reviewed to confirm intravenous antibiotics use prior to ERCP. PEP was defined based on new onset abdominal pain requiring hospitalization for at least 2 nights and increase in serum lipase and/or amylase ≥3 times the upper limit of the normal level at least 24 hours after the procedure. Results: Two hundred eighty ERCPs were performed during the study period; the average patient age was 63.1 years, with 158 females, and 36 patients with history of pancreatitis. Patients were divided in those taking intravenous antibiotics (n=88) and control group (n=192) who did not take antibiotics. Fifteen patients developed PEP, 7 of 88 patients (7.9%) taking antibiotics and 8 of 192 (4.1%) not taking antibiotics (p=0.205). The following factors were found to be significantly associated with an increased incidence of PEP, history of PEP, female sex, and difficult cannulation/failed attempt. Conclusion: Our study did not show any evidence to support a role for antibiotics (piperacillin and tazobactam, ciprofloxacin, cefoxitin) in decreasing the incidence or severity of PEP.