Antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage: A randomized trial

• Published in: Journal of pharmacology & pharmacotherapeutics Vol. 6; no. 1; pp. 24 - 29
• Main Authors: Agarwal, Ajit, Kumar, Sathasivam Suresh, Sadasivan, Jagdish, Kate, Vikram
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2015; Sage Publications Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Antibiotic prophylaxis; Antibiotics; Consent; Endoscopy; Hemorrhage; Hypertension; Infections; Intubation; Liver cirrhosis; Methods; Mortality; Prevention; Research Paper; Studies; Urinary tract diseases; Urogenital system; India; endoscopic variceal ligation; Child–Pugh score; rebleeding index; esophageal varices; ofloxacin prophylaxis; hemetemesis
• ISSN: 0976-500X; 0976-5018
• DOI: 10.4103/0976-500X.149139

To assess the role of antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage. A total of 60 patients who underwent endoscopic therapy for bleeding esophageal varices were randomized into the prophylaxis group and the on-demand group. Patients in the prophylaxis group received antibiotic prophylaxis using intravenous ofloxacin till the patient resumed oral fluids, followed by oral ofloxacin tablet for a total of 7 days. In the on-demand group, antibiotics were used only when infection was evident. Patients were monitored for rebleeding and infection during the hospital stay. A total of 30 patients in the prophylaxis group and 26 patients in the on-demand group were analyzed. The clinical characteristics in both the groups were similar. The Child-Pugh score was around 7 in both the groups. The incidence of infection was 5/30 (16.7%) in the prophylaxis group and 7/26 (26.9%) in the on-demand group (P = 0.52). The incidence of early rebleeding in the prophylaxis vs. the on-demand group was 3 vs. 5 (P = 0.69), and the incidence of late rebleeding was 6 vs. 8 (P = 0.48). The differences were not significant. The present study shows a trend toward lower rate of early and late rebleeding, infection rate and mortality in the prophylaxis group; hence, routine use of antibiotics in all such patients may not be necessary. Further studies with a larger sample size and a longer follow-up period are required to validate the usefulness of antibiotics in these patients.