Effect of a single-dose antibiotic prophylaxis in scheduled bile duct interventions in primary sclerosing cholangitis

The recommended duration of antibiotic prophylaxis in scheduled ERCP for patients with primary sclerosing cholangitis (PSC) varies greatly across international guidelines. Increasing antibiotic resistance makes the rational use of antibiotics urgently necessary. Therefore, we aimed to investigate the effect of an antibiotic single-dose prophylaxis on the rate of postinterventional cholangitis, the antibiotic exposure, and potential risk factors for cholangitis in this cohort.

A registry-based, noninterventional cohort study was conducted to investigate the effect of a newly introduced standard operating procedure (SOP) with a peri-interventional single-dose prophylaxis (SOP cohort, n = 80 procedures) compared with a historical cohort (n = 100 procedures) receiving a multiday regimen. Tokyo guidelines from 2018 were adapted for diagnosis and severity grading of cholangitis.

The duration of the peri-interventional antibiotic therapy differed significantly between cohorts, with a median of 0.33 days in the SOP cohort and 3.50 days in the historical cohort (P < .001), whereas no significant difference in the rate of post-ERCP cholangitis between the cohorts was found, even in procedures with dilation. When cholangitis severity was dichotomized into grade I versus grade II + III, the SOP cohort showed a significantly higher proportion of moderate to severe cholangitis (45.5% vs 9.1%; P < .001). Identified significant risk factors (in univariate analysis) for a post-ERCP cholangitis were the presence of a traditional dominant stricture and the subsequent performance of dilation during ERCP (odds ratio [OR], 3.360; P = .034, and OR, 3.356; P = .033, respectively).

In our study in patients with PSC, the antibiotic single-dose prophylaxis in scheduled ERCPs was not associated with a higher rate of postinterventional cholangitis, but with an increase in the cholangitis grade compared with a multiday regimen, indicating a potentially comparable effectiveness in preventing postinterventional cholangitis.