Abstract :
Background: According to the AASLD guidelines, fluoroquinolone and ceftriaxone are both recommended
as antibiotics of choice for prophylaxis in cirrhotic patient with gastrointestinal bleeding (GIB). Limited
studies exist comparing the efficacy of these two agents.
Objective: To compare the efficacy of intravenous ceftriaxone and ciprofloxacin for the prevention of
bacterial infections in cirrhotic patients with GIB.
Methods: Overall 273 cirrhotic patients with GIB were enrolled between 2007 and 2010. Eighty four
eligible patients were randomly assigned to receive either intravenous ceftriaxone or intravenous ciprofloxacin. All
patients received intravenous octreotide and underwent esophagogastroduodenoscopy (EGD) with standard therapeutic
approach. Blood cultures were routinely performed at initial, 2 hours post EGD, and at day 3. A 10-day
infection rate, 10-day rebleeding rate, length of stay (LOS) and mortality during admission were recorded.
Results: Forty four cirrhotic patients with GIB were enrolled in each group. The baseline characteristics
were not different between the groups. Suspected breakthrough infection rate within 10 days between ceftriaxone
and ciprofloxacin groups was the same (22% and 22%). Gram-negative bacilli were isolated from followed up
hemocultures in two patients in the ciprofloxacin-group. One patient was infected with extended spectrum betalactam
(ESBL) organism and finally died. Rebleeding rate, LOS and mortality rates were similar in the two groups.
Conclusions: The efficacy of intravenous ceftriaxone and ciprofloxacin for the prevention of bacterial
infection in cirrhotic patients with GIB is similar. The rates of breakthrough bacterial infections, rebleeding and
mortality were not significantly different between two groups.
Key words : Prevention, ciprofloxacin, ceftriaxone, bacterial infection, cirrhotic, gastrointestinal bleeding |
file/Thai-Journal-of-gastroenterology-vol-17-no-1-744350.pdf