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A French national survey on the use of antibiotic prophylaxis in cirrhotic patients
Author(s) -
Thevenot Thierry,
Degand Thibault,
Grelat Natacha,
Elkrief Laure,
Christol Camille,
Moreau Richard,
Henrion Jean,
Cadranel JeanFrançois,
Sheppard Frances,
Bureau Christophe,
Martino Vincent,
Pauwels Arnaud
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12093
Subject(s) - medicine , spontaneous bacterial peritonitis , ceftriaxone , amoxicillin , antibiotic prophylaxis , norfloxacin , ofloxacin , clavulanic acid , cephalosporin , gastrointestinal bleeding , antibiotics , medical prescription , gastroenterology , ciprofloxacin , cirrhosis , pharmacology , microbiology and biotechnology , biology
Summary Background Guidelines recommend antibiotic prophylaxis ( AP ) in well‐selected groups of cirrhotic patients, but the impact of these recommendations has not been assessed in France. Aim To evaluate AP prescription tendencies for gastrointestinal bleeding, and primary and secondary prophylaxis of spontaneous bacterial peritonitis ( SBP ). Methods Practitioners ( n = 1,159) working in general hospitals ( GH ) or in university hospitals ( UH ) received a self‐administered questionnaire. Results Three hundred and eighty‐nine (33.6%; GH 35% and UH 30.4%) practitioners responded. AP was prescribed by 97.7%, 72.3% and 94.8% of practitioners, without significant differences between UH and GH , respectively, for gastrointestinal bleeding (quinolones 48.2%, third‐generation cephalosporins 27.7% and amoxicillin‐clavulanic acid 22.2%), primary (quinolones 97.2%) and secondary prophylaxis of SBP (quinolones 99%). For gastrointestinal bleeding, ofloxacin (47.6%) and norfloxacin (37.4%) were the main quinolones prescribed, and ceftriaxone (77%) was the main third‐generation cephalosporin prescribed. The principal reasons for prescribing AP were a decrease in bacterial infection (88.9% for gastrointestinal bleeding, 91.3% for primary and 94.3% for secondary prophylaxis of SBP ), a recommendation by a consensus conference (83%, 38% and 74.4% respectively) and an improvement in survival (72.8%, 41.3% and 57.7% respectively). Only 31.7% of practitioners (39.6% for UH vs. 28.6% for GH ; P = 0.038) believed that AP may reduce the risk of bleeding recurrence. Reported side effects (28%) of AP mainly concerned the risk of quinolone resistance (62% of cases). Conclusion Antibiotic prophylaxis is well‐recognized by French practitioners, but its routine use depends on the expertise of practitioners. Quinolones remain the main antibiotic class prescribed irrespective of the type of prophylaxis.