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Evidence summaries

Antibiotic Prophylaxis in Cirrhotic Patients with Gastrointestinal Bleeding

Antibiotic prophylaxis (for 7 days) reduces the occurrence of infections and probably improves survival in cirrhotic patients with gastrointestinal bleeding. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 12 studies with a total of 1 241 subjects assessing the benefits and harms of antibiotic prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Antibiotic prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), the incidence of bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity. Five additional trials evaluated the effects of antibiotics compared with a different regimen of antibiotics in 650 patients. Data could not be combined as each trial used different interventions. None of the examined antibiotic regimens was superior to the control regimen regarding mortality or the incidence of bacterial infections.

A systematic review 2 including 5 studies with a total of 534 subjects was abstracted in DARE. The outcomes assessed were infection, bacteraemia and/or spontaneous bacterial peritonitis (SBP), and death. Antibiotic prophylaxis significantly increased the mean percentage of patients free of infection (86% of the patients remained free of infection in the intervention groups compared to 55% in the control groups; OR 4.64, 95% CI 3.19 to 6.75). The percentage of patients free of bacteraemia and/or SBP was 92% in the intervention groups and 73% in the control groups (OR 3.86, 95% CI 2.45 to 6.06). The mean survival rate was 85% in the intervention groups vs 76% in the control groups (OR 1.88, 95% CI 1.22 to 2.89).

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References

  • Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FI, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010;(9):CD002907. [PubMed].
  • Bernard B, Grangé JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999 Jun;29(6):1655-61. [PubMed] [DARE]

Primary/Secondary Keywords