Bacterial infection may adversely affect the hemostasis of patients with gastroesophageal variceal bleeding (GEVB).
In this study, physicians from Taiwan evaluated patients with acute GEVB but without evidence of bacterial infection over a 25 month period.
Patients were randomized to receive either prophylactic antibiotics (n=59) or antibiotics only when infection became evident (n=61) (on-demand group).
The team performed endoscopic therapy for GEVB immediately after infection work-up and randomization.
|Bacterial infection and hepatocellular carcinoma were independent predictors of rebleeding.|
The physicians found that antibiotic prophylaxis significantly decreased infections.
In addition, they determined that the actuarial probability of rebleeding was higher in patients without prophylactic antibiotics.
The team established that the difference in rebleeding was mainly due to early rebleeding within 7 days. They calculated that the relative hazard of rebleeding within 7 days was 5.078.
They found that bacterial infection (relative hazard 3.85) and hepatocellular carcinoma (relative hazard 2.46) were independent predictors of rebleeding.
The need for blood transfusion for rebleeding was reduced in the prophylactic group.
The physicians found no difference in survival between the 2 groups.
Dr Ming-Chih Hou and colleagues concluded, "Antibiotic prophylaxis can prevent infection and rebleeding as well as decrease the amount of blood transfused for patients with acute GEVB following endoscopic treatment".