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©2013 UpToDate ® Print Email Antibiotic prophylaxis for endoscopic procedures Patient condition Procedure contemplated Antibiotic prophylaxis High risk: Prosthetic heart valve or prosthetic material used for valve repair History of endocarditis Unrepaired cyanotic congenital heart disease (including palliative shunts and conduits) Repaired congential heart disease with residual defects at the site of or adjacent to a prosthetic device Completely repaired congenital heart defects with prosthetic material or device during the first six months after the repair Cardiac valvulopathy in a transplanted heart Stricture dilation Variceal sclerotherapy ERCP/obstructed biliary tree Not recommended Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation Not recommended Moderate risk: Most other congenital abnormalities Acquired valvular dysfunction (eg, rheumatic heart disease) Hypertrophic cardiomyopathy Mitral valve prolapse with regurgitation or thickened leaflets Esophageal stricture dilation Variceal sclerotherapy Not recommended Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation Not recommended Low risk: Other cardiac conditions (CABG, repaired septal defect or patent ductus, mitral valve prolapse without valvular regurgitation, isolated secundum atrial septal defect, physiologic/functional/innocent heart murmurs, rheumatic fever without valvular dysfunction, pacemakers, implantable defibrillators) All endoscopic procedures Not recommended Obstructed bile duct without cholangitis ERCP with complete drainage Not recommended Obstructed bile duct with cholangitis ERCP with anticipated incomplete drainage Recommended (continue antibiotics after procedure) Pancreatic cystic lesion ERCP, EUS-FNA Recommended Cirrhosis acute gastrointestinal bleed (required for patients with or without endoscopic procedures) All endoscopic procedures Recommended Ascites, immunocompromised patient Stricture dilation Variceal sclerotherapy Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation No recommendation All patients Percutaneous endoscopic feeding tube placement Recommended (parenteral cephalosporin or equivalent) Vascular graft AHA: Recommended antibiotic usage within 6 months of procedure ASGE: Antibiotics not recommended Prosthetic joints All endoscopic procedures Not recommended

Other endoscopic procedures, including EGD and colonoscopy (with or without biopsy/polypectomy), variceal ligation No recommendation All patients Percutaneous endoscopic feeding tube placement Recommended (parenteral cephalosporin or equivalent) Vascular graft AHA: Recommended antibiotic usage within 6 months of procedure ASGE: Antibiotics not recommended Prosthetic joints All endoscopic procedures Not recommended This summary table is based upon recommendations from the American Society of Gastrointestinal Endoscopy (Banerjee, S, Shen, B, Baron, T, et al. Gastrointest Endosc 2008; 67:791) and the American Heart Association (Wilson, W, Taubert, KA, Gewitz, M, et al. Circulation 2007; 116:1736 and Nishimura, RA, Carabello, BA, Faxon, DP, et al. Circulation 2008; 118:887). NOTE: See other table ("Antibiotic regimens: Prophylaxis for endoscopic procedures") for specific regimens. CABG: coronary artery bypass graft; ERCP: endoscopic retrograde cholangiopancreatography; EGD: esophagogastroduodenoscopy; EUS-FNA: endoscopic ultrasound with fine needle aspiration; AHA: American Heart Association; ASGE: American Society for Gastrointestinal Endoscopy. Modified with permission from: Hirota WK, Petersen K, Baron TH, et al. Guidelines for Antibiotic Prophylaxis for GI Endoscopy. Gastrointest Endosc 2003; 58:475. Copyright © 2003 Elsevier.