Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study

Abstract

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.

Fig. 1

Actuarial probability of remaining free of rebleeding in the patients in terms of prophylactic and on-demand antibiotics use. The difference between the groups was statistically significant (p=0.0035 by log-rank test).

Fig. 2

Actuarial probability of remaining free of early rebleeding in the patients in terms of prophylactic and on-demand antibiotics use. The difference between the groups was statistically significant (p=0.0085 by log-rank test).

Fig. 3

Actuarial probability of remaining free of late rebleeding in the patients in terms of prophylactic and on-demand antibiotics use. The difference between the groups was not significant (p=0.0943 by log-rank test).

Fig. 4

Actuarial probability of survival in the patients in terms of prophylactic and on-demand antibiotics use. The difference between the groups was not significant (p=0.4165 by log-rank test).