Pre-endoscopic antibiotics for the prevention of bacterial endocarditis: do we use them appropriately?

Because native valve bacterial endocarditis following endoscopic procedures is extremely rare, recent guidelines have discouraged indiscriminate use of pre-endoscopic antibiotics. The purpose of this study was to determine whether these guidelines have had an impact in prescribing antibiotic prophylaxis prior to endoscopic procedures.

All ambulatory endoscopic procedures carried out from January 1, 1992, through December 31, 1992, in a 412-bed community hospital in Northern Virginia were reviewed to identify cases receiving antibiotic prophylaxis. Inpatients, percutaneous gastrostomies, and ERCPs were not included, since many had received antibiotics for reasons other than endocarditis prophylaxis. We also surveyed a random sample of board certified gastroenterologists practicing at teaching hospitals in Northern Virginia and Washington, DC, to determine their practice patterns. We used the recent recommendations of the American Heart Association with minor modification as the "appropriate" guideline.

Only 10% of physicians use antibiotic prophylaxis appropriately. Most physicians over-utilize antibiotics in a variety of settings that do not require such measures. Conversely, many physicians do not prescribe antibiotics for disorders which do require prophylaxis.

Although "appropriate" guidelines for prophylactic antibiotics are available, and we have estimated the risk of acquiring native valve bacterial endocarditis following endoscopic procedures to be only 1 in 5-10 million procedures, the majority of physicians do not use prophylactic antibiotics appropriately.