Role of Antibiotics Use in Patients with Cirrhosis and Acute Variceal Bleeding: Single Center Experience

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Purpose: The use of short-term prophylactic antibiotics in patients with cirrhosis and gastrointestinal hemorrhage with or without ascites has been shown not only to decrease the rate of bacterial infections but also to increase survival. Our aim is to study the performance rate of prophylactic antibiotics in the era after publication of AASLD guidelines “Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis” in Sep 2007. Methods: We retrospectively reviewed our patients between Oct 2007 and Oct 2009 in the setting of a single tertiary medical center. Patients who received EGD with the diagnosis of esophageal (EV) or gastric varices (GV) were identified. All patients with liver cirrhosis and confirmed acute variceal hemorrhage were analyzed. Results: 216 patients who received EGD had the post-procedure diagnosis of EV or GV during the 2-year period after the publication of AASLD guidelines. 9 (4.2%) patients were identified with acute variceal hemorrhage. Among them, 8 patients had EV bleeding, and one had GV bleeding. 7 (78%) were given antibiotics, and two did not receive antibiotics during hospitalization. Only one patient received antibiotics at the emergency room. The other 6 (86%) were given antibiotics after hospitalization. Hepatologists prescribed antibiotics on 4 patients, while internists prescribed on the other 3. None was prescribed by emergency physician. The patients received either ciprofloxacin, levofloxacin or amoxicillin/clavulanic acid. All patients who received IV antibiotics continued to receive oral antibiotics after discharge for a total of 7-10 days. Conclusion: Prophylactic antibiotics were widely used in patients with acute variceal bleeding at our center. Further studies may be needed to assess the role of educational tools to help implement AASLD guidelines by ED physicians and internists in all patients with liver cirrhosis presenting with gastrointestinal bleeding.