Evaluation of Antibiotic Prophylaxis in the Prevention of Rebleeding in Acute Variceal Hemorrhage: An Institutional Based Study
Background: Upper gastrointestinal (GI) variceal bleeding is associated with significant mortality in cirrhosis. Guidelines of major GI societies adopt the use of antibiotics in acute variceal bleeding due to its efficacy in the reduction of bacteremia and spontaneous bacterial peritonitis. The recommendations on the choice of antibiotics are however based on a limited number of studies and mostly with small sample sizes.
Aim of the study: To evaluate antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage.
Materials and methods: Endoscopy were performed as soon as possible and EVL or endoscopic variceal sclerotherapy (EVS) was performed as indicated. Post endoscopic therapy, patients were kept nil per oral and intravenous fluids for at least 24 h. After the endoscopic therapy, patients included in the study were randomized into two groups, Group 1 and Group 2. Patients in group 1 received antibiotic prophylaxis with intravenous ofloxacin 200 mg q12h for 2 days or till the oral fluids were allowed followed by oral ofloxacin 200 mg q12h for a total of 7 days. Patients in group 2 did not receive antibiotic prophylaxis on presentation. Antibiotics were used only when infection was suspected or established.
Results: There were 20 patients each in Group 1 and 2. Number of male patients in group 1 and group 2 were 11 and 13, respectively. Number of female patients in group 1 and group 2 were 9 and 7, respectively. We observed that the incidence of infections was more significant in group 2 as compared to group 1.
Conclusion: Within the limitations of the present study, it can be concluded that infection rate is less significant in the prophylaxis group when compared with the control group, but the differences were not significant probably due to small sample size and short follow-up.
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