title: Antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage: A randomized trial.
abstract: OBJECTIVE
  To assess the role of antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage.
  
  
  METHODS
  A total of 60 patients who underwent endoscopic therapy for bleeding esophageal varices were randomized into the prophylaxis group and the on-demand group. Patients in the prophylaxis group received antibiotic prophylaxis using intravenous ofloxacin till the patient resumed oral fluids, followed by oral ofloxacin tablet for a total of 7 days. In the on-demand group, antibiotics were used only when infection was evident. Patients were monitored for rebleeding and infection during the hospital stay.
  
  
  RESULTS
  A total of 30 patients in the prophylaxis group and 26 patients in the on-demand group were analyzed. The clinical characteristics in both the groups were similar. The Child-Pugh score was around 7 in both the groups. The incidence of infection was 5/30 (16.7%) in the prophylaxis group and 7/26 (26.9%) in the on-demand group (P = 0.52). The incidence of early rebleeding in the prophylaxis vs. the on-demand group was 3 vs. 5 (P = 0.69), and the incidence of late rebleeding was 6 vs. 8 (P = 0.48). The differences were not significant.
  
  
  CONCLUSIONS
  The present study shows a trend toward lower rate of early and late rebleeding, infection rate and mortality in the prophylaxis group; hence, routine use of antibiotics in all such patients may not be necessary. Further studies with a larger sample size and a longer follow-up period are required to validate the usefulness of antibiotics in these patients.
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Sathasivam Suresh
authors.initials: SS
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Sadasivan
authors.affiliation: Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Kate
keywords: Child–Pugh score; endoscopic variceal ligation; esophageal varices; hemetemesis; ofloxacin prophylaxis; rebleeding index