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 on-demand 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.