Antibiotic prophylaxis in cirrhosis patients with upper gastrointestinal bleeding: An updated systematic review and meta‐analysis

Abstract

ObjectiveEmerging evidence suggest that antibiotic prophylaxis may be omitted in early cirrhosis patients with upper gastrointestinal bleeding (UGIB), which question the benefits of antibiotic prophylaxis on rebleeding, mortality related to ongoing bleeding, and the need for salvage therapy. As the management of UGIB has improved over time since the last review a decade ago, we performed an updated meta‐analysis to review the benefits of antibiotic prophylaxis in cirrhosis patients with UGIB.MethodSix electronic databases including PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane library, and ClinicalTrial.gov were systematically searched up to December 1, 2021. The primary outcome was 6 weeks mortality. Secondary outcomes include the risk of infection, rebleeding at 7 days and 6 weeks, mortality related to ongoing bleeding, need for salvage therapy, and infection‐related mortality.ResultEighteen studies (12 randomized controlled trials [RCT], 6 non‐RCT) from 3180 subjects were identified among 2129 citations. Antibiotic prophylaxis reduces mortality at 6 weeks, risk of infection, and infection‐related mortality (pooled relative risk: 0.72, 0.39, and 0.41, respectively). Although antibiotics reduce the risk of rebleeding and the amount of blood transfusion, they did not reduce the risk of mortality from ongoing bleeding nor the need for salvage therapy. Antibiotic prophylaxis may shorten the length of stay in the intensive care unit.ConclusionAntibiotic prophylaxis reduces rebleeding, 6‐week mortality, and infection‐related mortality. Due to the low risk of infection and death, dedicated studies are warranted to evaluate the benefit of antibiotic prophylaxis in early cirrhosis with UGIB.

Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure

“…An emerging concept proposed is identifying risk factors and possible avoidance of antibiotics in patients with well-preserved liver functions presenting with VH, however, prospective validation is needed (27,28). Although the model for end-stage liver disease (MELD) is reasonable in predicting outcomes of patients with VH, a recent study reported MELD-Lactate to be superior in predicting mortality after VH (29,30).…”

Stories behind the cover

“…3,4 The cover image for the third issue described the benefit of antibiotic prophylaxis for patients with early cirrhosis and upper gastrointestinal bleeding. 5 This updated meta-analysis on 18 studies and 3180 cirrhotic patients found that antibiotic prophylaxis reduced mortality at 6 weeks, risk of infection, and infectionrelated mortality. 5 The idea of this study reminded the illustrators of Butterflies in Love with Flowers, a legendary song poetry in Chinese culture.…”

“…5 This updated meta-analysis on 18 studies and 3180 cirrhotic patients found that antibiotic prophylaxis reduced mortality at 6 weeks, risk of infection, and infectionrelated mortality. 5 The idea of this study reminded the illustrators of Butterflies in Love with Flowers, a legendary song poetry in Chinese culture. The painting metaphorically represented the stomach and bleeding as a vase and red flowers while prophylactic antibiotic treatment as a butterfly.…”