Antibiotic Prophylaxis Using Third Generation Cephalosporins Can Reduce the Risk of Early Rebleeding in the First Acute Gastroesophageal Variceal Hemorrhage: A Prospective Randomized Study.
10.3346/jkms.2006.21.5.883
- Author:
Chung Hwan JUN
1
;
Chang Hwan PARK
;
Wan Sik LEE
;
Young Eun JOO
;
Hyun Soo KIM
;
Sung Kyu CHOI
;
Jong Sun REW
;
Sei Jong KIM
;
Young Dae KIM
Author Information
1. Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Esophageal and Grastric Varices;
Variceal Bleeding;
Liver Cirrhosis;
Antibiotic Prophylaxis;
Bac-terial Infections
- MeSH:
Recurrence;
Prospective Studies;
Middle Aged;
Male;
Humans;
Hemostasis;
Gastrointestinal Hemorrhage/*prevention & control;
Female;
Esophageal and Gastric Varices/*complications/mortality;
Cephalosporins/*therapeutic use;
Bacterial Infections/prevention & control;
*Antibiotic Prophylaxis;
Aged;
Adult
- From:Journal of Korean Medical Science
2006;21(5):883-890
- CountryRepublic of Korea
- Language:English
-
Abstract:
Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the ondemand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.
