Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

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Role of ciprofloxacin in patients

with cholestasis after endoscopic

retrograde cholangiopancreatography

World J Gastroenterol 2007 January;13(2):276-279

Ratanachu-ek T, Prajanphanit

P, Leelawat K, Chantawibul

S, Panpimanmas S, Subwongcharoen

S, Wannaprasert J.

Department of Surgery, Rajavithi Hospital, Rajavithi Rd, Rajathevi, Bangkok, Thailand.

AIM: To determine the role of ciprofloxacin in reducing cholangitis in cholestatic

patients with adequate biliary drainage after endoscopic

retrograde cholangiopancreatography (ERCP). METHODS: A randomized, controlled trial was performed in

48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP: 600 cases per year). All the 48 patients received 200 mg ciprofloxacin

intravenous injection for 30 min before starting any procedures, and then were

randomly divided in two groups. Twenty-two patients in

study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and

blood (in cholangitis) and clinical cholangitis were recorded. RESULTS:

Forty-eight patients were enrolled and divided into continuous ciprofloxacin

treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n =

26). During ERCP, stones were found in 22 patients,

malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin

and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP

developed cholangitis (relative risk = 0.71; 95% CI =

0.14-3.65; P = 0.88). Bacterobilia

was found in 27 (56.3%) out of 48 patients. E. coli

and Streptococcus viridans were the most common

organisms. CONCLUSION: Continual use of

ciprofloxacin in patients with cholestasis after

adequate biliary drainage procedures plays no role in reducing cholangitis.

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