Antibiotic prophylaxis for colonoscopy in cirrhotics

✍ Scribed by Todd H. Baron

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 34 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20646

✦ Synopsis

We appreciate the interest of Dr. Yarze, who raises an excellent question regarding the selection of cirrhotic patients undergoing colonoscopy who should receive prophylactic antibiotics. Although there are case reports of serious bacteremia following colonoscopy in cirrhotic patients, [1][2][3][4] results from a prospective study in cirrhotics undergoing colonoscopy have shown a low risk of bacteremia. 5 None of the 58 patients (with and without ascites) developed true bacteremia after the colonoscopy (in 4 patients blood cultures grew skin flora, presumed to be contaminants). All patients, even those with positive blood cultures, remained asymptomatic during the 72 hours after the endoscopic procedure and none returned to hospital because of fever, chills, or abdominal pain in the first 2 weeks after the procedure. No infectious episodes were recorded in the scheduled follow-up visits.

The American Society for Gastrointestinal Endoscopy does not currently recommend routine antibiotic prophylaxis for cirrhotic patients undergoing colonoscopy, 6 and our lack of recommendations was intentionally vague because the safety and efficacy of antibiotic prophylaxis in this setting are unclear. Potential indicators of a greater risk for infectious complications in cirrhotic patients undergoing colonoscopy may include ascites with low ascitic fluid protein, 8 recent gastrointestinal bleeding, 8 hospitalized patients, 9 presence of active colitis, 1,4 fulminant hepatic failure, 8 prior history of spontaneous bacterial peritonitis, 7 and prior history of bacteremia following colonoscopy. Clinicians, however, should decide upon antibiotic prophylaxis in these patients on an individual case basis. More data and study are needed before definitive recommendations can be made.