title: A French national survey on the use of antibiotic prophylaxis in cirrhotic patients.
abstract: BACKGROUND
  Guidelines recommend antibiotic prophylaxis (AP) in well-selected groups of cirrhotic patients, but the impact of these recommendations has not been assessed in France.
  
  
  OBJECTIVE
  To evaluate AP prescription tendencies for gastrointestinal bleeding, and primary and secondary prophylaxis of spontaneous bacterial peritonitis (SBP).
  
  
  METHODS
  Practitioners (n = 1,159) working in general hospitals (GH) or in university hospitals (UH) received a self-administered questionnaire.
  
  
  RESULTS
  Three hundred and eighty-nine (33.6%; GH 35% and UH 30.4%) practitioners responded. AP was prescribed by 97.7%, 72.3% and 94.8% of practitioners, without significant differences between UH and GH, respectively, for gastrointestinal bleeding (quinolones 48.2%, third-generation cephalosporins 27.7% and amoxicillin-clavulanic acid 22.2%), primary (quinolones 97.2%) and secondary prophylaxis of SBP (quinolones 99%). For gastrointestinal bleeding, ofloxacin (47.6%) and norfloxacin (37.4%) were the main quinolones prescribed, and ceftriaxone (77%) was the main third-generation cephalosporin prescribed. The principal reasons for prescribing AP were a decrease in bacterial infection (88.9% for gastrointestinal bleeding, 91.3% for primary and 94.3% for secondary prophylaxis of SBP), a recommendation by a consensus conference (83%, 38% and 74.4% respectively) and an improvement in survival (72.8%, 41.3% and 57.7% respectively). Only 31.7% of practitioners (39.6% for UH vs. 28.6% for GH; P = 0.038) believed that AP may reduce the risk of bleeding recurrence. Reported side effects (28%) of AP mainly concerned the risk of quinolone resistance (62% of cases).
  
  
  CONCLUSIONS
  Antibiotic prophylaxis is well-recognized by French practitioners, but its routine use depends on the expertise of practitioners. Quinolones remain the main antibiotic class prescribed irrespective of the type of prophylaxis.
authors.affiliation: Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Universitaire Jean Minjoz, Besançon, France. tthevenot@chu-besancon.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Thevenot
authors.forename: Thibault
authors.initials: T
authors.lastname: Degand
authors.forename: Natacha
authors.initials: N
authors.lastname: Grelat
authors.forename: Laure
authors.initials: L
authors.lastname: Elkrief
authors.forename: Camille
authors.initials: C
authors.lastname: Christol
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Jean
authors.initials: J
authors.lastname: Henrion
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Frances
authors.initials: F
authors.lastname: Sheppard
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Vincent
authors.initials: V
authors.lastname: di Martino
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pauwels
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents