Preparation of the Patient for Biliary Surgical or Interventional Procedures: Antibiotic Prophylaxis

Prophylactic antibiotic administration is indicated for all biliary tract procedures, surgical or interventional. Biliary bacteriology is important to antibiotic selection with the Enterobacteriaceae and Enterococcus predominating infectious complications. In patients who are not ill and who have not had previous biliary manipulation, a first-generation cephalosporin is adequate. In those patients undergoing routine procedures and having an indwelling stent, a second-generation cephalosporin offers expanded gram-negative coverage. In ill patients, an extended spectrum penicillin (± aminoglycosides), carbapenems, or fluoroquinolones can be used. Advantages and disadvantages of the agents are discussed.