Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy

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Abstract
Objective: To determine the efficacy of antibacterial prophylaxis in preventing infectious complications after percutaneous endoscopic gastrostomy. Design: Prospective, randomised, placebo controlled, double blind, multicentre study. Setting: Departments of internal medicine at six German hospitals. Subjects: Of 106 randomised adult patients with dysphagia, 97 received study medication, and 84 completed the study. The median age of the patients was 65 years. Most had dysphagia due to malignant disease (65%), and many (76%) had serious comorbidity. Interventions: A single intravenous 2.2 g dose of co-amoxiclav or identical appearing saline was given 30 min before percutaneous endoscopic gastrostomy performed by the thread pull method. Main outcome measures: Occurrence of peristomal wound infections and other infections within one week after percutaneous endoscopic gastrostomy. Results: The incidence of peristomal and other infections within one week after percutaneous endoscopic gastrostomy was significantly reduced in the antibiotic group (8/41 (20%) v 28/43 (65%), Pv 11/43 (26%), Pv 9 (21%), PConclusions: Antibiotic prophylaxis with a single dose of co-amoxiclav significantly reduces the risk of infectious complications after percutaneous endoscopic gastrostomy and should be recommended. Percutaneous endoscopic gastrostomy for enteral feeding can be associated with substantial rates of infectious complications, notably peristomal wound infection Small, single centre studies on prevention of wound infection by antibiotic prophylaxis have given conflicting results This prospective, randomised, placebo controlled, double blind, multicentre study showed that a single dose of 2.2 g co-amoxiclav significantly reduced the rate of infection The favourable effect of antibiotic prophylaxis included a reduction in the rate of clinically important peristomal wound infection Intention to treat analysis indicated a significant reduction in the need for therapeutic antibiotics