Antibiotic Use in Cirrhotic Patients with Upper GI Bleeds

Fri, 02/03/2017 - 11:29am
Author: 
Kara Huston, MD
  • Antibiotic use in patients with upper GI bleeding and concomitant liver cirrhosis is a common practice. However, have you ever wondered where that recommendation comes from and what are the benefits?
  • 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. 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
  • There were no serious adverse events reported and in a separate review conducted on 5 trials comparing different antibiotic regimens, no particular regimen was found to be superior to the control used in each trial.
  • Therefore, the recommnadation is to give antibiotics in cirrhotic patients with UGB and base your antibiotic choice on your local antibiogram for coverage against enteric bacteria
 
References