Saadeddin A et al. (2005) Antibiotic prophylaxis for percutaneous endoscopic gastrostomy for non-malignant conditions: a double-blind prospective randomized controlled trial. Aliment Pharmacol Ther 22: 565–570

Current guidelines recommend routine antibiotic prophylaxis to reduce the incidence of infection associated with percutaneous endoscopic gastrostomy (PEG), an intervention that facilitates nutritional support of patients unable to feed adequately by mouth. Results of previous studies are mixed, however, and some have shown no benefit for prophylactic antibiotics.

Saadeddin et al. suggest that this contradiction might be due to heterogeneity of patient groups; infection rates associated with PEG are known to be higher for patients with malignant conditions. Their prospective, double-blind, randomized, controlled study aimed to determine whether prophylactic antibiotic treatment conferred a benefit on patients undergoing PEG for nonmalignant conditions.

In all, 99 patients were included in the analysis, 51 of whom received a single dose of antibiotics selected according to British Society of Gastroenterology guidelines (either 2.2 g co-amoxiclav, n = 43; or 2 g cefotaxime, n = 8 penicillin-allergic patients), and 48 of whom received placebo. The groups were similar in demographics and indications for PEG. Peristomal and systemic infection rates were significantly lower in the antibiotic-treated group (P = 0.001 and P = 0.0238, respectively). The most common organism isolated from peristomal swabs (from 9 patients, all in the placebo group) was methicillin-resistant Staphylococcus aureus; the antibiotic treatment regime used would not be expected to prevent these infections, but the patients' baseline status for this organism was unknown. These results support the use of antibiotic prophylaxis in patients with nonmalignant conditions undergoing PEG, say the authors.