Antibiotic Use in Cirrhotic Patients with Upper GI Bleeds
Antibiotic use in patients with upper GI bleeding and concomitant liver cirrhosis is standard of care. However, have you ever wondered where that recommendation comes from and what exactly the benefits are? A Cochrane Review in 2010 analyzed the literature and included 12 randomized clinical trials that evaluated antibiotic prophylaxis compared to placebo or no antibiotic prophylaxis in cirrhotic patients with an upper GI bleed. No serious events were reported. Their findings are displayed below:
|
|
Relative Risk |
95% CI |
|
Overall mortality |
0.79 |
0.63-0.98 |
|
Mortality from bacterial infection |
0.43 |
0.19-0.97 |
|
Bacterial infections |
0.36 |
0.27-0.49 |
|
Rebleeding |
0.53 |
0.38-0.74 |
|
Bacteremia |
0.25 |
0.15-0.40 |
|
Pneumonia |
0.45 |
0.27-0.75 |
|
SBP |
0.29 |
0.15-0.57 |
|
UTI |
0.23 |
0.12-0.41 |
A separate review was conducted on 5 trials that compared different antibiotic regimens. No particular regimen was found to be superior to the control used in each trial.
Recommendation:
- Give antibiotics in cirrhotic patients with UGIB
- Base your antibiotics choice on your local antibiogram for coverage against enteric bacteria
References: