Letter

Antibiotic prophylaxis after percutaneous endoscopic gastrostomy insertion

BMJ 2000; 320 doi: 10.1136/bmj.320.7238.870/a (Published 25 March 2000)
Cite this as: BMJ 2000;320:870.2

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All encompassing study is needed

  1. D S Sanders, gastroenterology research fellow.,
  2. M J Carter, gastroenterology research fellow. (cooper@helix.mgh.harvard.edu)
  1. Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF
  2. Department of Gastroenterology, Russells Hall Hospital, Dudley DY9 ODT
  3. Medical Clinic, Klinikum Minden, D-32427 Minden, Germany
  4. Department of Medicine, University Hospital and Medical Center, D-89070 Ulm, Germany

    EDITOR—Preclik et al reported an incidence of 65% peristomal infection in their control group.1 This is considerably higher than in previous studies, where rates vary from 19% to 29.4%.2–4 This discordance can be explained by considering the indications for gastrostomy insertion. This feeding method is used in five broad categories of patients—cerebrovascular disease, neurodegenerative conditions, malignancy (primarily oropharyngeal or oesophageal), dementia with anorexia, and head injuries. In the previous studies malignancy represented 14.8-21.1%, 2–4 whereas in Preclik's cohort it is 65%.

    Previous studies have implied that patients with underlying malignancy are more susceptible to peristomal infection.2 This mayexplain the high infection rate in the controls of this study and therefore the benefit of antibiotics in this particular patient subgroup. This, however, cannot necessarily be extrapolated to other indications for gastrostomy insertion. The British Society of Gastroenterology has indicated that this is an area requiring further evaluation.5 We require a similar study encompassing all the conditions for which gastrostomies are inserted in the United Kingdom to resolve this issue.

    References

    1. 1.↵
      1. Preclik G,
      2. Grune S,
      3. Leser J,
      4. Lebherz W,
      5. Machka K,
      6. Holstege A,
      7. et al
      . Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy. BMJ 1999; 319: 881–884. (2 October.)
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      1. Sturgis TM,
      2. Yancy W,
      3. Cole JC,
      4. Proctor DD,
      5. Minhas BS,
      6. Marcuard SP
      . Antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1996; 91: 2301–2304.
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      1. Jain NK,
      2. Larson DE,
      3. Schroeder KW,
      4. Burton DD,
      5. Cannon KP,
      6. Thompson RL,
      7. et al
      . Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A randomised, double-blind clinical trial. Ann Intern Med 1987; 107: 824–828.
    4. 4.↵
      1. Jonas SK,
      2. Neimark S,
      3. Panwalker AP
      . Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1985; 80: 438–441.
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    5. 5.↵
      1. British Society of Gastroenterology
      . Antibiotic prophylaxis in gastrointestinal endoscopy. Guidelines in gastroenterology. Gut 1996(suppl). (September 1996.)

    Widespread routine use of prophylactic antibiotics might predispose to increased risk of resistant organisms

    1. I Mohammed, specialist registrar.,
    2. B J M Jones, consultant gastroenterologist. (B.J.M.J@btinternet.com)
    1. Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF
    2. Department of Gastroenterology, Russells Hall Hospital, Dudley DY9 ODT
    3. Medical Clinic, Klinikum Minden, D-32427 Minden, Germany
    4. Department of Medicine, University Hospital and Medical Center, D-89070 Ulm, Germany

      EDITOR—In their paper Preclik et al conclude that antibiotic prophylaxis reduces infections after percutaneous endoscopic gastrostomy insertion as recommended by the American, European, and French societies of gastrointestinal endoscopy.1 We believe that this paper does not provide the evidence required to introduce such a practice in the United Kingdom, a position supported by the 1996 guidelines from the British Society of Gastroenterology.

      Preclik et al found a significantly higher infection rate in the control group, with an astonishing overall infection rate of 65% representing peristomal and other infections.1 Even when only the most clinically significant wound infections were …

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