Antibiotics Before Endoscopy

Excerpt

To the editor: The letter of Goldman and associates (1) supplies important information about bacteremia after flexible sigmoidoscopy. Their study is well done, but I believe their conclusion—that patients with cardiac lesions predisposing to endocarditis should be treated with prophylactic antibiotics before flexible sigmoidoscopy—is in error for several reasons

First, a huge number of patients would have to be "protected"; 6.3% of American women have mitral valve prolapse (2). When persons with other valvular and congenital heart disease are added, there will be a very large expense for and risk from the antibiotics administered.

Second, the incidence of bacteremia reported