title: Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding.
abstract: BACKGROUND
  Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic prophylaxis seems to decrease the incidence of bacterial infections. Oral antibiotics, active against enteric bacteria, have been commonly used as antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002.
  
  
  OBJECTIVE
  To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with upper gastrointestinal bleeding.
  
  
  METHODS
  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies.
  
  
  METHODS
  Randomised clinical trials comparing different types of antibiotic prophylaxis with no intervention, placebo, or another antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding.
  
  
  METHODS
  Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes.
  
  
  RESULTS
  Twelve trials (1241 patients) evaluated antibiotic prophylaxis compared with placebo or no antibiotic prophylaxis. All trials were at risk of bias. Antibiotic prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different antibiotic regimens. Data could not be combined as each trial used different antibiotic regimen. None of the examined antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections.
  
  
  CONCLUSIONS
  Prophylactic antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of antibiotic used; thus, no specific antibiotic can be preferred. Therefore, antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.
authors.affiliation: Medica Sur Clinic & Foundation, Puente de Piedra 150, Mexico City, Mexico, 14050.
authors.forename: Norberto C
authors.initials: NC
authors.lastname: Chavez-Tapia
authors.forename: Tonatiuh
authors.initials: T
authors.lastname: Barrientos-Gutierrez
authors.forename: Felix I
authors.initials: FI
authors.lastname: Tellez-Avila
authors.forename: Karla
authors.initials: K
authors.lastname: Soares-Weiser
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
mesh_terms: D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
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