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Ceftriaxone vs ciprofloxacin as antibiotic profilaxis after esophageal variceal bleeding ; facts or fiction?

INTRODUCTION: Esophageal variceal bleeding (EVB) is the most serious complication of portal hypertension and is assotiated with a high mortality rate. Up to 62% of cirrhotic patients with EVB may encounter bacterial infections. The use of profilactic antibiotics during EVB is proven to be effective in reducing bacterial infections and has been advocated as a standard procedure. AIMS & METHODS: The aim of this study was to determine which antibiotic prophylaxis is better in prevention infection after esophageal variceal bleeding (EBV). The Patients and Methods: 60 pts presenting with EBV without bacterial infection admitted to an ICU (51M/9F, mean age 49.5 yrs) were studied. All patients had emergent upper endoscopy with sclerotherapy. The patients divided into two groups: Group A: 30 pts treated prophylactic with iv ceftriaxone 1 gr every12 hours, 5 days. Group B - 30 pts treated with ciprofloxacin 200 mg iv, 5 days. The 0both group were comparable by sex, age, BMI, elevated serum C-reactive protein, endoscopic findings, time to endoscopic treatment, Child classification, alcohol abuse, smoking, history of previous EVB and bleeding severity. The effect variables were: duration of stay in ICU, bacterial infection, number of rebleeding and mortality in first 6 days. The hemoglobin level was checked twice per day, during five days. The blood transfusion was given if the hemoglobin concentration fell 8.5 gm/ dcl or if vital signs deteriorated. A clinician independent of the endoscopist observed the patients for evidence of rebleeding and evidence of infection in period time after sclerotherapy. The definition of rebleeding was recurrent hemorrhage during 6 days observation period. The definition of infection were: increased elevated serum C-reactive protein, fever, leucocytosis, and tachicardia. For data analysis Chi-Square test, Friedman test and T-test were used. RESULTS: The duration of stay in ICU in Group A was significantly lower than in Group B (4.6 days vs 7.5 days), P < 0.001. The overall bleeding recurrence rate in Group A was significantly lower than that in Group B [4 pts from 30 pts (12%) versus 8 pts from 30pts (26%)], P < 0.001. The incidence of bacterial infections was significantly lower in Group A than in Group B [4 pts from 30 pts (13.3%) versus 8 pts from 30 pts (26.66%)], P < 0.001. A difference in mortality rate has also been demonstrated - in Group A hospital mortality was 9% and in Group B was 21%, P < 0.001. CONCLUSION: Our preliminary data suggest that iv ceftriaxone is more effective than iv ciprofloxacin in the prophylaxis of bacterial infection in cirrhotic patients with EBV. This therapy should be applied as soon as possible.

Ceftriaxone; ciprofloxacin; antibiotic profilaxis; variceal bleeding

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