The value of prophylactic antibiotic therapy during endoscopic retrograde cholangiopancreatography

Prophylactic antibiotics have been recommended during endoscopic retrograde cholangiopancreatography in the hope of preventing septic complications. However, their effectiveness has not been proved clinically. In this study, the ability of the pancreas to secrete ampicillin, gentamicin and clindamycin after a single intravenous dosage, given prior to endoscopic retrograde cholangiopancreatography in 12 patients, was examined. Simultaneously obtained serum antibiotic levels were within the expected therapeutic range. In contrast, pancreatic ductal levels of ampicillin and gentamicin were too low to be measured in most patients. Most patients had measurable clindamycin levels which ranged from 12.0 to 3.1 micrograms per milliliter in seven patients and was 8.0 micrograms per milliliter in one patient. Parenteral prophylactic antibiotic coverage for endoscopic retrograde cholangiopancreatography is ineffective with gentamicin or ampicillin. Clindamycin may be of value, but it needs further study at higher dosages.