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endocarditis prophylaxis - procedures in the gastrointestinal tract

Content version
U-89.2
Updated
10/20/2025 - 14:00

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  • Only for diagnostic or therapeutic endoscopies in which antibiotics are administered to prevent wound infection or sepsis. In such cases the antibiotics administered should also be targeted against enterococci.

    For example:

    - ERCP in a patient with (suspected) biliary obstruction

    - Treatment of a Zenker's diverticulum
  • Gastrointestinal surgery, biliary tract surgery

    Antibiotics administered to prevent wound infection or sepsis should also be active against enterococci.\\
  • Endocarditis prophylaxis is NOT indicated for procedures such as:
  1. Gastroduodenoscopy with or without biopsy
  2. Colonoscopy with or without biopsy/polypectomy
  3. Dilatation of the oesophagus
  4. Banding of haemorrhoids
  5. Coagulation therapy
  6. Sclerotherapy
  7. ERCP with or without sphincterotomy in a patient without (suspected) biliary obstruction
  8. PEG insertion
  9. Liver biopsy or other ultrasound-guided punctures
  10. Endoscopic ultrasound (EUS)
  11. Laparotomy (clean-contaminated procedure with risk of wound infection <15%)
  • If any of the procedures mentioned above indicates prophylactic administration of antibiotics to prevent wound infection or sepsis, an agent active against enterococci should also be added, such as:
    • Adults:

      amoxicillin 3 g orally, preferably as a dispersible formulation, 30-60 minutes before the procedure.
    • Children:

      amoxicillin suspension 50 mg/kg orally, maximum 3 g, 30-60 minutes before the procedure.
    • Adults:

      amoxicillin 2 g IV, 30-60 minutes before the procedure.
    • Children:

      amoxicillin 50 mg/kg IV, maximum 2 g, 30-60 minutes before the procedure.
  • In case of penicillin hypersensitivity or treatment with penicillin in the 7 days before the procedure:
    • Adults:

      vancomycin 1 g IV, 1-2 hours before the procedure.
    • Children:

      vancomycin 10 mg/kg IV, maximum 1 g, 1-2 hours before the procedure.