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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 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).
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Figure 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).

Mentions: Twenty patients and 24 patients died in the prophylactic and on-demand group, respectively. Total mortality and 30-day mortality were not different between the two groups (Table 7). The overall rate of survival was similar between the two groups (Fig. 4). Univariate analysis showed that the survival was significantly related to the presence of HCC, Child-Pugh's score, and bacterial infection (Table 8). On multivariate analysis, presence of HCC (relative hazard: 4.134, 95% CI: 2.261-7.560, p<0.001) and Child-Pugh's score (relative hazard: 1.372, 95% CI: 1.173-1.603, p<0.001) were two independent risk factors determining survival.


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

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

Figure 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).
Mentions: Twenty patients and 24 patients died in the prophylactic and on-demand group, respectively. Total mortality and 30-day mortality were not different between the two groups (Table 7). The overall rate of survival was similar between the two groups (Fig. 4). Univariate analysis showed that the survival was significantly related to the presence of HCC, Child-Pugh's score, and bacterial infection (Table 8). On multivariate analysis, presence of HCC (relative hazard: 4.134, 95% CI: 2.261-7.560, p<0.001) and Child-Pugh's score (relative hazard: 1.372, 95% CI: 1.173-1.603, p<0.001) were two independent risk factors determining survival.

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