The role of prophylactic antibiotics in prevention of spontaneous bacterial peritonitis in compensated liver cirrhosis with upper gastrointestinal bleeding: randomized controlled, clinical trial

Abstract

Background and aim Acute variceal bleeding is one of the major causes of death in cirrhotic patients. Bacterial infection is one of the common complications with acute variceal bleeding. Using prophylactic antibiotic is controversial in Child–Pugh-A patients with acute variceal bleeding. In this respect, we aimed to assess the impact of using prophylactic antibiotic in Child-A cirrhotic patients presented with upper gastrointestinal bleeding (UGIB) in prevention of spontaneous bacterial peritonitis (SBP). Patient and methods From January 2021 to December 2022, we recruited 68 cirrhotic patients presented with UGIB. We divided our patients into two groups: prophylactic group (34 patients) and control group (34 patients). Clinical evaluation, laboratory investigations, and ultrasound of the abdomen all were done at baseline and followed up for 7 days during admission for signs of bacterial infection, especially SBP (NCT04711122). Results The infections that we encountered were SBP (three cases in the prophylaxis group and seven cases in the control group) and pneumonia (one case in the control group). There was no statistically significant difference between the two groups regarding the incidence of ascitic fluid infection (8.8 vs. 20.6%, P=0.15). There was insignificant difference between both groups as regards hospital stay, blood transfusion, admission to the ICU, and mortality. Conclusion Cirrhotic patients with Child class A who presented with UGIB and received antibiotic prophylaxis did not get benefit regarding the incidence of bacterial infections, mortality, or frequency of admission to the ICU.

Keywords

• antibiotics; cirrhosis; prophylactic; spontaneous bacterial peritonitis; upper gastrointestinal bleeding