Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis

• Published in: PloS one Vol. 17; no. 12; p. e0279496
• Main Authors: Gao, Yanying, Qian, Baoxin, Zhang, Xu, Liu, Hua, Han, Tao
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.12.2022; Public Library of Science (PLoS)
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - adverse effects; Antibiotics; Bacteria; Bacterial diseases; Bacterial infections; Bacterial Infections - drug therapy; beta-Lactams; Bias; Biology and Life Sciences; Bleeding; Care and treatment; Cirrhosis; Complications and side effects; Confidence intervals; Disease prevention; Dosage and administration; Evaluation; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - etiology; Health risks; Hemorrhage; Heterogeneity; Humans; Infections; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - drug therapy; Medicine and Health Sciences; Meta-analysis; Mortality; Prevention; Prophylaxis; Quinolones; Risk; Risk factors; Sepsis; Statistical analysis; Subgroups; β-Lactam antibiotics; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0279496

To evaluate the effect of different prophylactic antibiotic treatments for cirrhosis patients with upper gastrointestinal bleeding (UGIB) and to investigate whether prophylactic antibiotics are equally beneficial to reducing the risk of adverse outcomes in A/B with low Child-Pugh scores. Relevant studies were searched via PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang, and VIP databases up to July 16, 2021. The heterogeneity test was conducted for each outcome measuring by I2 statistics. Subgroup analysis was performed regarding antibiotic types. Relative risk (RR) and 95% confidence interval (CI) were used to evaluate prophylactic antibiotics on the risk of adverse outcomes in cirrhosis patients with UGIB. Twenty-six studies involving 12,440 participants fulfilled our inclusion criteria. Antibiotic prophylaxis was associated with a reduced overall mortality (RR: 0.691, 95%CI: 0.518 to 0.923), mortality due to bacterial infections (RR: 0.329, 95%CI: 0.144 to 0.754), bacterial infections (RR: 0.389, 95%CI: 0.340 to 0.444), rebleeding (RR: 0.577, 95%CI: 0.433 to 0.767) and length of hospitalization [weighted mean difference (WMD): -3.854, 95%CI: -6.165 to -1.543] among patients with UGIB. Nevertheless, prophylactic antibiotics may not benefit to A/B population with low Child-Pugh scores. In our subgroup analysis, quinolone, beta-lactams alone or in combination reduced adverse outcomes in cirrhosis patients with UGIB. Administration of antibiotics was associated with a reduction in mortality, bacterial infections, rebleeding, and length of hospitalization. Quinolone, beta-lactams alone or in combination can be used in cirrhosis patients with UGIB. Nevertheless, targeted efforts are needed to promote the appropriate use of antibiotics among patients with cirrhosis and UGIB.