Bugs and bleeding varices ▸

Several lines of evidence indicate that patients with cirrhosis presenting with gastrointestinal bleeding have a higher risk of developing bacterial infection and this in turn may be associated with early rebleeding. A meta-analysis of randomised controlled trials concluded that antibiotic prophylaxis not only reduced the incidence of infections in these patients but also improved survival. Despite this, antibiotic prophylaxis does not seem to have become common practice in patients with variceal bleeding.

Hou et al randomised 120 patients with acute gastro-oesophageal variceal bleeding, without any evidence of infection at the time of presentation, to receive prophylactic antibiotic (ofloxacin 200 mg twice daily for seven days) or to be treated with antibiotics when infection became evident (on demand). Clinical and endoscopic findings, timing, and type of endoscopic therapy were similar in the two groups. The incidence of bacterial infection was much lower in patients receiving prophylactic antibiotics than that in the on demand group (3.4% v 26%). Antibiotic prophylaxis …