Single-Versus Multiple-Dose Antimicrobial Prophylaxis in Peroral Endoscopic Myotomy: A Randomized Controlled Study...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Infectious Disease Prevention

Background:

• Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for esophageal motility disorders.
• Prophylactic antibiotics are commonly used during POEM, but their optimal duration is debated.
• Reducing antibiotic exposure is crucial to combat antimicrobial resistance.

Purpose of the Study:

• To compare the incidence of infections between single-dose (SD-A) and multiple-dose (MD-A) antibiotic prophylaxis after POEM.
• To evaluate secondary outcomes including fever, inflammatory markers, and antibiotic-related adverse events.

Main Methods:

• A prospective, randomized, non-inferiority trial involving 114 patients undergoing POEM.
• Patients were randomized to receive either a single dose or three days of a third-generation cephalosporin.
• Infections, fever, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin levels were monitored.

Main Results:

• The incidence of post-POEM infections was similar between the SD-A and MD-A groups (3.5% overall; 1.7% vs 5.3%, p=0.618).
• Post-procedure inflammatory markers (CRP, ESR, procalcitonin) and fever rates were comparable in both groups.
• No significant difference in antibiotic-related adverse events was noted.

Conclusions:

• Single-dose antibiotic prophylaxis is non-inferior to multiple-dose prophylaxis for POEM.
• Elevated inflammatory markers and fever post-POEM likely indicate inflammation, not necessarily infection.
• These findings support de-escalation of antibiotic duration in POEM procedures.