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

Jun CH, Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ, Kim YD - J. Korean Med. Sci. (2006)

Bottom Line: 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).In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

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.

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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).
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Figure 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).

Mentions: Summary of hemostatic outcome data is outlined in Table 3. The rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (21/62, 33.9% vs. 36/58, 62.1%, p=0.004). The difference of rebleeding was mostly due to early rebleeding within 6 weeks (3/62, 4.8% vs. 12/58, 20.7%, p=0.012). The cumulative total rebleeding rate and early rebleeding rate were also higher in the on-demand group (Fig. 1, 2). However, there was no significant difference in cumulative late rebleeding rate between the two groups (Fig. 3). The rebleeding sources were not different between the two groups (Table 2). The early rebleeding rate in the infected patients was significantly higher than that in the noninfected patients (4/11, 36.4% vs. 11/109, 10.1%, p=0.031). However, there was no difference in total rebleeding rate between the infected and the noninfected (6/11, 54.5% vs. 52/109, 47.7%, p=0.760). The transfusion requirement was significantly larger in on-demand group than that in prophylactic group (p=0.002). There were no differences in rebleeding index, treatment failure, and duration of hospital stay between the two groups.


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

Jun CH, Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ, Kim YD - J. Korean Med. Sci. (2006)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2722000&req=5

Figure 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).
Mentions: Summary of hemostatic outcome data is outlined in Table 3. The rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (21/62, 33.9% vs. 36/58, 62.1%, p=0.004). The difference of rebleeding was mostly due to early rebleeding within 6 weeks (3/62, 4.8% vs. 12/58, 20.7%, p=0.012). The cumulative total rebleeding rate and early rebleeding rate were also higher in the on-demand group (Fig. 1, 2). However, there was no significant difference in cumulative late rebleeding rate between the two groups (Fig. 3). The rebleeding sources were not different between the two groups (Table 2). The early rebleeding rate in the infected patients was significantly higher than that in the noninfected patients (4/11, 36.4% vs. 11/109, 10.1%, p=0.031). However, there was no difference in total rebleeding rate between the infected and the noninfected (6/11, 54.5% vs. 52/109, 47.7%, p=0.760). The transfusion requirement was significantly larger in on-demand group than that in prophylactic group (p=0.002). There were no differences in rebleeding index, treatment failure, and duration of hospital stay between the two groups.

Bottom Line: 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).In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

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.

Show MeSH
Related in: MedlinePlus