Davis A J, Kolios G, Alveyn C G, Robertson D A
Department of Gastroenterology, Royal United Hospital, Bath, UK.
Aliment Pharmacol Ther. 1998 Mar;12(3):207-11. doi: 10.1046/j.1365-2036.1998.00291.x.
Cholangitis and septicaemia are serious complications of endoscopic retrograde cholangiopancreatography (ERCP). They occur mainly following therapeutic ERCP in the setting of an obstructed biliary system. The optimum prophylactic antibiotic regimen in such patients is not yet defined but usually depends on intravenous agents.
To compare the efficacy of oral ciprofloxacin with intravenous cephazolin.
One hundred and fifty patients at high risk from septic complications were randomized prospectively to either oral ciprofloxacin (750 mg b.d.) or intravenous cephazolin (1 g b.d.), commenced at least 90 min prior to the ERCP and continued for 3 days. Bacteriological cultures were taken from bile during the procedure and from blood both immediately and at 24 h post-procedure.
There were no significant differences between the two treatment groups in the pre-ERCP clinical or radiological findings or in the types of procedure performed. One patient did not undergo an ERCP and was excluded from the final analysis. Of the 77 patients in the ciprofloxacin group there were no positive blood cultures and one positive culture from a nasobiliary drain. Two out of the 72 cephazolin patients had positive blood cultures immediately post-ERCP; one of these two patients and one other cephazolin patient had positive bile cultures. There were no cases of cholangitis or septicaemia in the ciprofloxacin group and three cases in the cephazolin group. One patient from each treatment group died within the 7-day study. Adverse drug reactions were minimal and none of the different clinical outcomes in the two groups reached statistical significance.
Oral ciprofloxacin is a cost-effective prophylactic agent for high-risk ERCP.
胆管炎和败血症是内镜逆行胰胆管造影术（ERCP）的严重并发症。它们主要发生在治疗性ERCP后，此时胆道系统存在梗阻。此类患者的最佳预防性抗生素方案尚未确定，但通常依赖于静脉用药。
比较口服环丙沙星与静脉注射头孢唑林的疗效。
150例有败血症并发症高风险的患者被前瞻性随机分为口服环丙沙星组（750毫克，每日两次）或静脉注射头孢唑林组（1克，每日两次），在ERCP前至少90分钟开始用药，并持续3天。在手术过程中从胆汁中采集细菌培养样本，并在术后即刻和术后24小时从血液中采集样本。
两组在ERCP前的临床或影像学表现或所进行的手术类型方面没有显著差异。1例患者未接受ERCP，被排除在最终分析之外。环丙沙星组的77例患者中，血培养均为阴性，鼻胆管引流液培养有1例阳性。头孢唑林组的72例患者中有2例在ERCP术后即刻血培养阳性；这2例患者中的1例以及另1例头孢唑林组患者胆汁培养阳性。环丙沙星组无胆管炎或败血症病例，头孢唑林组有3例。每个治疗组各有1例患者在7天的研究期内死亡。药物不良反应轻微，两组不同的临床结局均未达到统计学显著性。
口服环丙沙星是高危ERCP患者具有成本效益的预防用药。
