Prophylactic Antibiotics in IR

• Biliary procedures: Mandatory before all biliary interventions. Ampicillin 1 g IV and gentamicin 80 mg IV immediately before procedure. Alternatively, a single dose of piperacillin/tazobactam (Zosyn) 4.5 g IV can be used before percutaneous transhepatic cholangiography. For biliary drainage, antibiotic coverage can be extended to two days following the procedure.
• Embolization (TAE, TACE) and ablation (RFA): Unproven to be of benefit in RFA, but may be given in some institutions. Patients with biliary abnormalities (e.g., bilioenteric anastomosis), immunosuppression, concomitant infection, or severe cirrhosis are at higher risk for abscess formation following RFA, but I haven't been able to find any solid recommendations for prophylactic antibiotics. We use Unasyn IV the day of and the day after, and discharge the patient on 5 days of Augmentin.
• Genitourinary: We use Cipro prior to urinary procedures. Some of our referring urologists prefer ampicillin and gentamicin immediately before the procedure.
• Line placement: Coverage may be given for skin flora per institutional protocols: cephazolin 1 g, clindamycin 300 mg, or vancomycin 500 mg.
• Diagnostic angiography: Only in asplenic and severely neutropenic patients. Use coverage for skin flora: cephazolin 1 g, clindamycin 300 mg, or vancomycin 500 mg. Patients with heart valves don't need antiobiotic prophylaxis.

References

• Choi D, Lim HK, Kim MJ, Kim SJ, Kim SH, Lee WJ, Lim JH, Paik SW, Yoo BC, Choi MS, Kim S. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR Am J Roentgenol. 2005 Jun;184(6):1860-7.
• Kaufman JA and Lee MJ. Multiple chapters in Vascular and interventional radiology: The Requisites. Mosby 20004.
• Sato S, Mishiro T, Miyake T, Okamoto E, Furuta K, Azumi T, Oshima N, Takahashi Y, Ishihara S, Adachi K, Amano Y, Kinoshita Y. Prophylactic administration of antibiotics unnecessary following ultrasound-guided biopsy and ablation therapy for liver tumors: Open-labeled randomized prospective study. Hepatol Res. 2009 Jan;39(1):40-6.
• Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology. 1988 Feb;166(2):381-7.