In cirrhotic patients with gastrointestinal bleeding, antibiotic prophylaxis decreases the incidence of infections but most randomized trials have not shown an increase in survival. The aim of this meta-analysis was to assess the efficacy of antibiotic prophylaxis in the prevention of infections and its effect on survival rate in cirrhotic patients with gastrointestinal bleeding. Four end points were assessed: infection, bacteremia and/or spontaneous bacterial peritonitis (SBP), incidence of SBP, and death. For each end point, heterogeneity and treatment efficacy were assessed by Der Simonian and Peto methods. Five trials including 534 patients, 264 treated with antibiotic prophylaxis for 4 to 10 days and 270 without, were identified. Mean follow-up was 12 days. Antibiotic prophylaxis significantly increased the mean percentage of patients free of infection (32% mean improvement rate, 95% confidence interval [CI]: 22-42, P F .001), bacteremia and/or SBP (19% mean improvement rate, 95% CI: 11-26, P F .001), and SBP (7% mean improvement rate, 95% CI: 2.1-12.6, P ؍ .006). Antibiotic prophylaxis also significantly increased the mean survival rate (9.1% mean improvement rate, 95 % CI: 2.9-15.3, P ؍ .004), without significant heterogeneity. In cirrhotic patients with gastrointestinal bleeding, short-term antibiotic prophylaxis significantly increases the mean percentage of patients free of infection and significantly increases short-term survival rate. (HEPATOLOGY 1999;29:1655-1661.)Bacterial infections are frequently diagnosed in patients with cirrhosis and gastrointestinal bleeding. Prospective studies have shown that bacterial infections are documented in 22% of such patients within the first 48 hours after admission. 1-3 Within 7 to 14 days after initial bleeding, the incidence of bacterial infections reaches 35% to 66% among studies. [3][4][5][6][7][8][9] Moreover, infections seem to be closely related to prognosis in bleeding cirrhotic patients. One study has shown that bacterial infections are the major factor predictive of rebleeding within 7 days. 3 A recent study showed that bacterial infection and the use of empirical antibiotic treatment are independently associated with failure to control variceal bleeding during the first 5 days. 4 Enteric bacteria are the most common agents of infection in cirrhotic patients. 1,10,11 A first randomized clinical trial (RCT) showed in 1985 that nonabsorbable antibiotics decreased the incidence of infection in bleeding patients. 5 Four other trials using quinolones alone or associated antibiotics have been performed in the same way. 5-9 Although these five RCTs have shown that the use of antibiotic prophylaxis decreases the incidence of infections, 5-9 only one trial has shown an increase in survival rate during the first 10 days without significant difference for mortality rate during the whole hospitalization. 5 The aim of the present meta-analysis was to assess the efficacy of antibiotic prophylaxis in the prevention of infections and its effect on survival rate in ...
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