Single Dose of Intravenous Antibiotics Before Peroral Endoscopic Myotomy Is Sufficient for Infection Prevention

Peroral endoscopic myotomy (POEM) is an endoscopic procedure that exposes the contents of the esophagus to the sterile mediastinum during the myotomy. This allows microbial translocation to occur and presents a risk of local and systemic infection. This study evaluated the role of single-dose intravenous (IV) antibiotics versus a short course of antibiotics in POEM patients. 

In this prospective randomized controlled trial, patients undergoing POEM were randomized to receive a single dose of a prophylactic antibiotic or a short course of antibiotics. The prophylaxis group (group A: n=62; age, 58.5 ± 14.6 years; 33 males) was given 2 gm of cefazolin intravenously before the procedure. The short-course antibiotic group (group B: n=62; age, 55.9 ± 15.35 years; 31 males) received 2 gm of cefazolin intravenously for 24 hours, followed by 3 mg of amoxicillin/clavulanate per day for 3 days. Patients allergic to beta-lactams were given an equivalent dose of clindamycin. 

Prior to hospitalization, initial lab work was collected to establish a baseline. Body temperature and repeat labs were obtained 1 hour before the procedure as well as 1 hour and 24 hours after the procedure. None of the enrolled patients developed a fever after POEM except 1 in group B. There were no differences in the absolute body temperatures between groups A and B. Furthermore, there were no significant differences between the 2 groups in systemic inflammation markers, such as C-reactive protein, white blood cell count 24 hours after POEM, lipopolysaccharide-binding protein, IL-6, and tumor necrosis factor-α. 

One hour before POEM, blood cultures from all patients were negative. One hour after POEM, 3 of 124 patients (2.4%) had positive blood cultures for Streptococcus spp, including 1 patient (1.6%) in the prophylaxis group and 2 (3.2%) in the short-course antibiotic group. All patients had negative blood cultures 24 hours after POEM, suggesting transient bacteremia in these 3 patients. At day 5 of follow-up after discharge, no infections, fevers, or other complications were reported.