[Prospective randomized trial of intravenous ciprofloxacin for prevention of bacterial infection in cirrhotic patients with esophageal variceal bleeding].
OBJECTIVE
In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding. The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding.


METHODS
From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t.


RESULTS
Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups.


CONCLUSIONS
In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.
Hong
Sung Noh
SN
Division of Gastroenterology and Gastrointestinal Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Beom Jin
BJ
Lee
Sun Young
SY
Lee
Choon Young
CY
Ryu
Min Kyu
MK
Choi
Moon Seok
MS
Lee
Joon Hyoek
JH
Rhee
Poong Lyul
PL
Koh
Kwang Cheol
KC
Kim
Jae J
JJ
Paik
Seung Woon
SW
Rhee
Jong Chul
JC
Choi
Kyoo Wan
KW
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006801:Humans; D007262:Infusions, Intravenous; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
D000890:Anti-Infective Agents; D002939:Ciprofloxacin