Single-Versus Multiple-dose Antimicrobial Prophylaxis for Peroral Endoscopic Myotomy in Achalasia

Treatment modalities include pharmacological therapy, endoscopic injection of botulinum toxin (Botox), pneumatic dilatation (PD), Laparoscopic Heller Myotomy (LHM) and Per Oral Endoscopic Myotomy (POEM). POEM is a novel minimally invasive treatment for achalasia, which emerged as an offshoot of natural orifice transluminal endoscopic surgery (NOTES). No longer considered as an experimental treatment POEM has achieved remarkable initial outcomes for treating achalasia with approximately 10,000 procedures performed worldwide till date. Numerous studies have focused on the efficacy, safety as well as technical aspects of POEM. Bacteremia can occur after endoscopic procedures and has been advocated as a surrogate marker for IE risk. The highest rates of bacteremia have been reported with esophageal dilation, sclerotherapy of varices, and instrumentation of obstructed bile ducts. However, few efforts have been made to the issue of antimicrobial prophylaxis in POEM. Postoperative prophylactic antibiotics are universally initiated on call to the operating room or at the start of POEM and consist of second‐generation cephalosporins. The mean duration of antibiotic regimen after POEM was 3 days ranging from 1 day to 7 days. Numerous studies have shown that a single dose of antibiotic prophylaxis in a variety of surgical procedures. Few studies have shown that prolonged administration of antibiotics for longer than 24 hours add no benefit in many surgeries. Prolonged use of antibiotics not only increases the costs and exposure to drug toxicity directly but also may be associated with an increased risk of acquired antibiotic resistance as well as infection with Clostridium difficile.