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Antimicrobial prophylaxis for gastrointestinal procedures: current practices in North American academic pediatric
1Division of Pediatric Gastroenterology, Nutrition, and Hepatology, University of California-San Francisco Medical Center, 94143, USA. jsnyder@peds.ucsf.edu
Journal of Pediatric Gastroenterology and Nutrition
|October 24, 2002
Summary
Pediatric antibiotic prophylaxis for endoscopy is limited to high-risk heart conditions and PEG tube placement. Current practices suggest a low risk of infection during pediatric endoscopic procedures.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Current guidelines for pediatric antibiotic prophylaxis during endoscopy are based on limited data regarding infection risks.
- Existing recommendations from the American Heart Association (AHA) and American Society of Gastroenterological Endoscopy (ASGE) identify high-risk pediatric patients and procedures.
- Limited data on bacteremia and sepsis in children undergoing endoscopy necessitates a review of current practices.
Purpose of the Study:
- To review the antibiotic prophylaxis practices of 15 major academic pediatric gastroenterology centers.
- To identify patterns in the use of antibiotic prophylaxis for specific pediatric conditions and endoscopic procedures.
- To assess the safety and consistency of antibiotic prophylaxis protocols in pediatric endoscopy.
Main Methods:
- A questionnaire was distributed to 15 academic centers in the US and Canada.
- The questionnaire queried antibiotic prophylaxis use for children with six conditions (varying congenital heart disease risks, immune compromise, central venous lines, ventriculo-peritoneal shunts).
- Six endoscopic procedures were evaluated: EGD with biopsy, sigmoidoscopy/colonoscopy with biopsy, ERCP, esophageal sclerotherapy, dilation, and PEG tube placement.
Main Results:
- Practices generally align with AHA and ASGE guidelines.
- Routine antibiotic prophylaxis was reported in approximately half of the 36 condition-procedure combinations.
- Prophylaxis was most common for moderate/high-risk congenital heart disease and PEG tube placement; it was rarely used for low-risk cardiac conditions, immunocompromised patients, or those with lines/shunts unless for PEG placement.
Conclusions:
- Routine antibiotic prophylaxis in pediatric academic centers is reserved for specific high-risk conditions and procedures.
- The findings indirectly suggest that infectious complications from pediatric endoscopic procedures are infrequent.
- Current practices indicate a conservative approach to antibiotic use in pediatric endoscopy, focusing on clearly defined high-risk scenarios.