Guideline for Prophylactic Antibiotic for Percutaneous Endoscopic Gastrostomy
Translocation of endogenous microbial flora can occur during
endoscopic procedures such as percutaneous endoscopic gastrostomy (PEG).1 While endoscopic related bacteremia
carries a low risk, with certain patient comorbidities and history of previous
procedures the risk increases.
Antibiotic prophylaxis can be useful for prevention of
infections related to some invasive procedures and in specific clinical
scenarios. Patients undergoing PEG tube
placement are at higher risk of bacteremia related to advanced age, compromised
nutritional status, immunosuppression, and comorbidities.1 Prophylactic
antibiotic therapy is recommended for these patients.1,2 The
therapy is recommended as pre-procedural and as a one-time dose.1,2 Cefazolin
that provides coverage for cutaneous organisms is adequate for this
therapy. In patients with
methicillin-resistant Staphylococcus
aureus (MRSA) decontamination is recommended.
Recommended antibiotic regimen:
Cefazolin 2g IV for
patients weighing less than 120 kg
Cefazolin 3g IV for patients weighing 120 kg or greater
Cefazolin 3g IV for patients weighing 120 kg or greater
If a history of a severe allergy to penicillin is present,
one of the following regimens may be used:
Clindamycin 900 mg IV
or
Vancomycin 15 mg/kg IV
PLUS
Gentamicin 5mg/kg IV or Aztreonam 2g IV or Levofloxacin 500 mg IV
PLUS
Gentamicin 5mg/kg IV or Aztreonam 2g IV or Levofloxacin 500 mg IV
1.
Antibiotic prophylaxis will be used in all
patients receiving a PEG placement in the OR, endoscopy suite, and ICUs.
2.
Antibiotics dosing should be weight-adjusted
3.
Antibiotic administration should occur within 60
minutes prior to incision, with the exception of vancomycin and
fluoroquinolones which should be administered within 120 minutes prior to
incision.
4.
The antibiotic infusion should be complete
before incision.
5.
Post procedure antibiotics are not warranted
outside of a present infection or contaminated procedure
References:
1.
American Society of Gastrointestinal Endoscopy.
Antibiotic prophylaxis for GI endoscopy. Gastrointestinal
Endoscopy. 2015 81(1): 81-89. http://dx.doi.org/10.16/j.gie.2014.08.008
2.
Ban, KA; Minei, JP; Laronga, C; Harbrecht, BG;
Jensen, EH; et al. American College of Surgeons and Surgical Infection Society:
Surgical Site Infection Guidelines, 2016 update. Amer Coll Surgeons. 2016; 10: 59-73. http://dx.doi.org/10.1016/j.jamcollsurg.2016.10.029
3.
Bratzler DW; Dellinger EP; Olsen KM; et al. Clinical
Practice Guidelines for Antimicrobial Prophylaxis in Surgery. AM J Health Syst
Pharm. 2013 70(3):195-283. DOI:
