title: Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study.
abstract: Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chung-Hwan
authors.initials: CH
authors.lastname: Jun
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Wan-Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Young-Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sung-Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Jong-Sun
authors.initials: JS
authors.lastname: Rew
authors.forename: Sei-Jong
authors.initials: SJ
authors.lastname: Kim
authors.forename: Young-Dae
authors.initials: YD
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control; D002511:Cephalosporins / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D002511:Cephalosporins