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Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta‐analysis
Author(s) -
Bernard Brigitte,
Grangé JeanDidier,
Khac Eric Nguyen,
Amiot Xavier,
Opolon Pierre,
Poynard Thierry
Publication year - 1999
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510290608
Subject(s) - medicine , spontaneous bacterial peritonitis , bacteremia , antibiotic prophylaxis , antibiotics , gastrointestinal bleeding , gastroenterology , incidence (geometry) , confidence interval , randomized controlled trial , cirrhosis , microbiology and biotechnology , physics , optics , biology
In cirrhotic patients with gastrointestinal bleeding, antibiotic prophylaxis decreases the incidence of infections but most randomized trials have not shown an increase in survival. The aim of this meta‐analysis was to assess the efficacy of antibiotic prophylaxis in the prevention of infections and its effect on survival rate in cirrhotic patients with gastrointestinal bleeding. Four end points were assessed: infection, bacteremia and/or spontaneous bacterial peritonitis (SBP), incidence of SBP, and death. For each end point, heterogeneity and treatment efficacy were assessed by Der Simonian and Peto methods. Five trials including 534 patients, 264 treated with antibiotic prophylaxis for 4 to 10 days and 270 without, were identified. Mean follow‐up was 12 days. Antibiotic prophylaxis significantly increased the mean percentage of patients free of infection (32% mean improvement rate, 95% confidence interval [CI]: 22‐42, P < .001), bacteremia and/or SBP (19% mean improvement rate, 95% CI: 11‐26, P < .001), and SBP (7% mean improvement rate, 95% CI: 2.1‐12.6, P = .006). Antibiotic prophylaxis also significantly increased the mean survival rate (9.1% mean improvement rate, 95 % CI: 2.9‐15.3, P = .004), without significant heterogeneity. In cirrhotic patients with gastrointestinal bleeding, short‐term antibiotic prophylaxis significantly increases the mean percentage of patients free of infection and significantly increases short‐term survival rate