title: Effectiveness of an aggressive antibiotic regimen for chemoembolization in patients with previous biliary intervention.
abstract: OBJECTIVE
  Liver abscess occurs in most patients with biliary stents or bypass undergoing chemoembolization despite the use of standard prophylactic antibiotics. The present study was conducted to investigate the efficacy of an aggressive prophylactic regimen to prevent abscess in such patients.
  
  
  METHODS
  Between November 2002 and July 2005, 16 chemoembolization procedures were performed in seven patients who had undergone biliary intervention. Prophylaxis was initiated with levofloxacin 500 mg daily and metronidazole 500 mg twice daily 2 days before chemoembolization and continued for 2 weeks after discharge. A bowel preparation regimen was given with neomycin 1 g plus erythromycin base 1 g orally at 1 p.m., 2 p.m., and 11 p. m. the day before chemoembolization. With the Fisher exact test, the incidence of infectious complications was compared with previously reported data for patients with and without earlier biliary intervention who had received standard prophylaxis.
  
  
  RESULTS
  Liver abscess occurred in two of seven patients after two of 16 procedures. Previously reported incidences were six of seven patients (P=.103) and six of 14 procedures (P=.101) among patients with previous biliary intervention receiving standard prophylaxis and one of 150 patients (P=.005) and one of 383 procedures (P=.004) among patients with no previous biliary intervention.
  
  
  CONCLUSIONS
  There was a trend toward a lower rate of abscess formation among patients at high risk who received more aggressive antibiotic prophylaxis, but the difference did not reach statistical significance. The rate of infection remained significantly higher than among patients without previous biliary intervention.
authors.affiliation: Division of Interventional Radiology, University of Pennsylvania, 1 Silverstein, 2400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Shalin
authors.initials: S
authors.lastname: Patel
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tuite
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001660:Biliary Tract Diseases / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic; D004322:Drainage / Q000295:instrumentation; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000008:administration & dosage; D006801:Humans; D064704:Levofloxacin; D008100:Liver Abscess / Q000382:microbiology / Q000517:prevention & control*; D008111:Liver Function Tests; D008795:Metronidazole / Q000008:administration & dosage; D009355:Neomycin / Q000008:administration & dosage; D015242:Ofloxacin / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D004917:Erythromycin; D064704:Levofloxacin; D015242:Ofloxacin; D009355:Neomycin