Antibiotic Prophylaxis after Endoscopic Therapy: Does it Prevent Rebleeding in Acute Variceal Hemorrhage?

Patients with cirrhosis complicated by gastroesophageal variceal bleeding (GEVB) are characterized by high mortality and rebleeding rates. These patients are particularly vulnerable to infections. Bacterial infection may adversely affect the hemostasis of patients with GEVB. Over a period of 10 months, patients with acute GEVB but without evidence of bacterial infection were randomized to receive prophylactic antibiotic or receive antibiotic only when infection is evident (on demand group). 30 patients in the prophylactic group and 30 patients in the on demand group were analysed. Clinical and endoscopic characteristics of the gastroesophageal varies, time of endoscopic treatment and period of follow up were not different between the two groups. Antibiotics decreased the incidence of infection (4/30, 13% vs. 14/30, 46%; p 0.002). There was no difference in survival between the two groups. In conclusion, antibiotic prophylaxis can prevent infection and rebleeding in patients with acute GEVB following endoscopic treatment.