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REPLY
Antibiotic Prophylaxis before Endoscopic Retrograde Cholangiopancreatography
Sven J. van den Hazel, MD, PhD;
Peter Speelman, MD, PhD; and
Dirk J. van Leeuwen, MD, PhD
15 June 1997 | Volume 126 Issue 12 | Pages 1001-1002
IN RESPONSE:
We appreciate the comments of Drs. Byl and Deviere and do not disagree with their suggestion that the "inadvertent" use of antibiotics after ERCP may have masked some cases of cholangitis. However, the primary question addressed in our study was related to the need for antibiotic prophylaxis before ERCP in patients who have a low preprocedure risk for cholangitis after ERCP because they have conditions in which satisfactory drainage is usually obtained (such as distal common bile duct obstruction due to cancer or gallstone disease). Our study showed that the routine use of antibiotic prophylaxis in these patients is not justified. However, findings during ERCP or failure to accomplish adequate drainage by the time the procedure is terminated may certainly justify initiating antibiotic therapy immediately after ERCP to prevent cholangitis in these high-risk patients. We believe that such a policy is in agreement with the findings of Byl and coworkers.
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Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands 1105 AZ
University of Alabama at Birmingham, Birmingham, AL 35294
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