Antibiotic prophylaxis in acute variceal hemorrhage

Abstract

Bacterial infection is a major problem in patients with cirrhosis and upper gastrointestinal hemorrhage. Incidence of infection ranges between 16 and 66 %. Clinical risk factors are poor liver function (Child-Pugh class C, ascites, jaundice, or hepatic encephalopathy), malnutrition, severity of the initial hemorrhage, and failure to control bleeding. Bacterial infection is independently associated to failure to control bleeding and rebleeding and increases hospital mortality. Antibiotic prophylaxis (oral norfloxacin in patients with preserved liver function and intravenous ceftriaxone in those with advanced cirrhosis) decreases the incidence of bacterial infection, improves bleeding control, prevents rebleeding, and reduces hospital mortality. Antibiotic prophylaxis is therefore an essential point in the management of patients with cirrhosis and acute variceal hemorrhage. The current chapter describes the pathogenesis, incidence, and clinical impact of bacterial infections in patients with cirrhosis and gastrointestinal bleeding and summarizes the prophylactic strategies currently recommended in this population.