title: Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding.
abstract: Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis.
authors.affiliation: Yeong Yeh Lee, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
authors.forename: Yeong Yeh
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Yeong Yeh Lee, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
authors.forename: Hoi-Poh
authors.initials: HP
authors.lastname: Tee
authors.affiliation: Yeong Yeh Lee, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control; D002939:Ciprofloxacin / Q000627:therapeutic use; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000382:microbiology / Q000503:physiopathology*; D005355:Fibrosis / Q000150:complications / Q000382:microbiology / Q000503:physiopathology*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000401:mortality; D006470:Hemorrhage; D006801:Humans; D009643:Norfloxacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D009643:Norfloxacin
keywords: Antibiotics; Cirrhosis; Infection; Prophylaxis; Variceal bleeding