Antibiotic prophylaxis after percutaneous endoscopic gastrostomy insertion

doi:10.1136/bmj.320.7238.870/a

BMJ 2000;320:870 ( 25 March )

Letters

Antibiotic prophylaxis after percutaneous endoscopic gastrostomy insertion

All encompassing study is needed

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

Long acting antibiotic is superior in reducing systemic complications

Author's reply

All encompassing study is needed

The first 150 words of the full text of this article appear below.

EDITOR $---$ Preclik et al reported an incidence of 65% peristomal infection in their control group.¹ This is considerably higherthan in previous studies, where rates vary from 19% to 29.4%.^2-4This discordance can be explained by considering the indicationsfor gastrostomy insertion. This feeding method is used in fivebroad categories of patients $---$ cerebrovascular disease, neurodegenerativeconditions, malignancy (primarily oropharyngeal or oesophageal),dementia with anorexia, and head injuries. In the previous studiesmalignancy represented 14.8-21.1%,^2-4 whereas in Preclik's cohortit is 65%.

Previous studies have implied that patients with underlying malignancy are more susceptible to peristomal infection.² Thismay explain the high infection rate in the controls of this studyand therefore the benefit of antibiotics in this particular patientsubgroup. This, however, cannot necessarily be extrapolated toother indications for gastrostomy insertion. The British Societyof Gastroenterology has indicated that this is an area requiringfurther evaluation.⁵ We . . . [Full text of this article]

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Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy: G Preclik, S Grüne, H G Leser, J Lebherz, W Heldwein, K Machka, A Holstege, and W V Kern
BMJ 1999 319: 881. [Abstract] [Full Text] [PDF]