title: Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP).
abstract: OBJECTIVE
  Considerable controversy exists regarding the role of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography (ERCP), in that various studies of antibiotic prophylaxis have reached conflicting conclusions. The aim of this meta-analysis is to synthesize the data in order to determine whether antibiotic prophylaxis reduces the rate of occurrence of bacteremia and/or the rate of sepsis/cholangitis among patients undergoing ERCP.
  
  
  METHODS
  Clinical trials were selected via Medline and Pubmed using subject words and textwords "ERCP", "antibiotic" and "antibiotic prophylaxis". Summary estimates of the risk ratios for the outcomes of bacteremia and sepsis/cholangitis were calculated.
  
  
  RESULTS
  After 49 abstracts had been reviewed, seven randomized placebo-controlled trials of antibiotic prophylaxis prior to ERCP were identified. Upon further review, two studies were excluded because patients received antibiotics before and after the ERCP. Four studies reported on the clinical outcome of bacteremia. Five studies reported on the clinical outcome of sepsis/cholangitis. The summary relative risk of the association between antibiotic prophylaxis and bacteremia was 0.39 (95% CI, 0.12-1.29). For sepsis/cholangitis the summary relative risk was 0.91 (95 % CI, 0.39-2.15).
  
  
  CONCLUSIONS
  Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia but this has little clinical relevance. Prophylaxis does not substantially reduce the incidence of sepsis/cholangitis and thus the routine use of antibiotic prophylaxis cannot be recommended.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. aharris@medicine.umaryland.edu
authors.forename: A
authors.initials: A
authors.lastname: Harris
authors.forename: A C
authors.initials: AC
authors.lastname: Chan
authors.forename: C
authors.initials: C
authors.lastname: Torres-Viera
authors.forename: R
authors.initials: R
authors.lastname: Hammett
authors.forename: D
authors.initials: D
authors.lastname: Carr-Locke
mesh_terms: D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000517:prevention & control*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000517:prevention & control*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome