title: The outcome of prophylactic intravenous cefazolin and ceftriaxone in cirrhotic patients at different clinical stages of disease after endoscopic interventions for acute variceal hemorrhage.
abstract: Antibiotic prophylaxis with norfloxacin, intravenous ciprofloxacin, or ceftriaxone has been recommended for cirrhotic patients with gastrointestinal hemorrhage but little is known about intravenous cefazolin. This study aimed to compare the outcome of intravenous cefazolin and ceftriaxone as prophylactic antibiotics among cirrhotic patients at different clinical stages, and to identify the associated risk factors. The medical records of 713 patients with acute variceal bleeding who had received endoscopic procedures from were reviewed. Three hundred and eleven patients were entered for age-matched adjustment after strict exclusion criteria. After the adjustment, a total of 102 patients were enrolled and sorted into 2 groups according to the severity of cirrhosis: group A (Child's A patients, n = 51) and group B (Child's B and C patients, n = 51). The outcomes were prevention of infection, time of rebleeding, and death. Our subgroup analysis results failed to show a significant difference in infection prevention between patients who received prophylactic cefazolin and those who received ceftriaxone among Child's A patients (93.1% vs. 90.9%, p = 0.641); however, a trend of significance in favor of ceftriaxone prophylaxis (77.8% vs. 87.5%, p = 0.072) was seen among Child's B and C patients. More rebleeding cases were observed in patients who received cefazolin than in those who received ceftriaxone among Child's B and C patients (66.7% vs. 25.0%, p = 0.011) but not in Child's A patients (32% vs. 40.9%, p = 0.376). The risk factors associated with rebleeding were history of bleeding and use of prophylactic cefazolin among Child's B and C patients. In conclusion, this study suggests that prophylactic intravenous cefazolin may not be inferior to ceftriaxone in preventing infections and reducing rebleeding among Child's A cirrhotic patients after endoscopic interventions for acute variceal bleeding. Prophylactic intravenous ceftriaxone yields better outcome among Child's B and C patients.
authors: Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
authors: Cheng-Kun
authors: CK
authors: Wu
authors: Jing-Houng
authors: JH
authors: Wang
authors: Chen-Hsiang
authors: CH
authors: Lee
authors: Keng-Liang
authors: KL
authors: Wu
authors: Wei-Chen
authors: WC
authors: Tai
authors: Sheng-Nan
authors: SN
authors: Lu
authors: Tsung-Hui
authors: TH
authors: Hu
authors: Seng-Kee
authors: SK
authors: Chuah
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000401:mortality; D016905:Gram-Negative Bacterial Infections / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D002437:Cefazolin
references: Hepatology. 2002 Jan;35(1):140-8
references: 11786970
references: Aliment Pharmacol Ther. 2011 Sep;34(5):509-18
references: 21707680
references: J Hepatol. 2010 Oct;53(4):762-8
references: 20638742
references: Gastroenterology. 1992 Oct;103(4):1267-72
references: 1397884
references: Hepatology. 1999 Jun;29(6):1655-61
references: 10347104
references: Br J Surg. 1973 Aug;60(8):646-9
references: 4541913
references: J Antimicrob Chemother. 2007 Sep;60(3):629-37
references: 17599919
references: Hepatology. 1996 Oct;24(4):802-6
references: 8855179
references: Gastrointest Endosc. 1994 Nov-Dec;40(6):680-4
references: 7859964
references: Antimicrob Agents Chemother. 1973 Oct;4(4):396-401
references: 4598612
references: Cochrane Database Syst Rev. 2002;(2):CD002907
references: 12076458
references: Hepatology. 2007 Sep;46(3):922-38
references: 17879356
references: Hepatology. 1994 Jul;20(1 Pt 1):34-8
references: 8020902
references: Hepatology. 2004 Mar;39(3):746-53
references: 14999693
references: Am J Gastroenterol. 1998 Jun;93(6):962-6
references: 9647029
references: Surg Endosc. 2011 Sep;25(9):2911-8
references: 21424196
references: Zhonghua Yi Xue Za Zhi (Taipei). 2002 Aug;65(8):365-71
references: 12455806
references: Hepatology. 1985 May-Jun;5(3):463-7
references: 3873389
references: Br J Clin Pharmacol. 2012 Jul;74(1):171-9
references: 22150975
references: Gastroenterology. 2006 Oct;131(4):1049-56; quiz 1285
references: 17030175
references: J Gastroenterol. 2003;38(2):153-7
references: 12640529
references: Gut. 1987 May;28(5):623-41
references: 3297941
references: N Engl J Med. 1988 Oct 13;319(15):983-9
references: 3262200
references: Gastrointest Endosc. 2008 May;67(6):791-8
references: 18374919