Antibiotic prophylaxis before endoscopy

Joseph David Feuerstein, MD, from the Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, in Boston, Massachusetts, USA describes this Original Article, “Current knowledge of antibiotic prophylaxis guidelines regarding GI open-access endoscopic procedures is inadequate.”

The purpose of our study was to assess the current knowledge of physicians who refer patients for endoscopic procedures. With the use of open-access endoscopy, many patients are sent directly for their endoscopic procedure without being evaluated by a gastroenterologist until the procedure.

The reason we felt this study was important, was that the guidelines recommending antibiotics prior to endoscopic procedures to prevent endocarditis were updated and changed in 2007/2008 to no longer recommend antibiotic prophylaxis prior to routine endoscopy. The prior data was based on case reports and poor evidence. However, the ability to change practice and recommend cessation of antibiotics is quite challenging. Given the risks of antibiotic resistance and complications from antibiotics we felt this was an important study to assess the current knowledge of referring providers regarding antibiotic usage prior to endoscopy.Our study queried 740 physicians at three medical centers about whether or not they would recommend antibiotics prior to endoscopic procedures in 10 theoretical scenarios. Our study found that gastroenterologists were more likely than primary care physicians or specialists to answer the theoretical scenarios regarding the use of antibiotics prior to endoscopic procedures correctly (P < .001). When broken down by level of training and specialty, the highest median scores for attending physicians were 9 among gastroenterologists (IQR 7-10) followed by 7 for infectious disease specialists, hospitalists, and cardiologists. In contrast, the highest median scores for trainees were 10 for gastroenterology trainees and 9 for infectious disease specialists and geriatrics trainees. Multivariable predictors of correct responses were self-reported familiarity with guidelines (0.21; 95% CI, 0.08-0.34; P = .002) and specialty (0.56; 95% CI, 0.30-0.82; P < .001) and inversely with year of medical school graduation (0.22; 95% CI, 0.07-0.37; P = .005).

Guidelines are meant to improve the safety and quality of healthcare provided. While this study did not assess the current use of antibiotics in clinical practice, based on these theoretical scenarios, physician knowledge regarding the current guidelines is inadequate. Practices should consider disseminating the current guideline recommendations regarding antibiotics prior to endoscopy to ensure the safety and quality of this procedure.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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