
Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice
Author(s) -
Alberto Ferrarese,
Nicola Passigato,
Caterina Cusumano,
S Gemini,
A. To,
Elton Dajti,
Giovanni Marasco,
Federico Ravaioli,
Antonio Colecchia
Publication year - 2021
Publication title -
world journal of hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.913
H-Index - 55
ISSN - 1948-5182
DOI - 10.4254/wjh.v13.i8.840
Subject(s) - medicine , cirrhosis , antibiotic prophylaxis , antibiotics , intensive care medicine , clinical practice , family medicine , microbiology and biotechnology , biology
Patients with cirrhosis show an increased susceptibility to infection due to disease-related immune-dysfunction. Bacterial infection therefore represents a common, often detrimental event in patients with advanced liver disease, since it can worsen portal hypertension and impair the function of hepatic and extra-hepatic organs. Among pharmacological strategies to prevent infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute variceal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. Nevertheless, antibiotic prophylaxis has to deal with the changing bacterial epidemiology in cirrhosis, with increased rates of gram-positive bacteria and multidrug resistant rods, warnings about quinolones-related side effects, and low prescription adherence. Short-term antibiotic prophylaxis is applied in many other settings during hospitalization, such as before interventional or surgical procedures, but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial stewardship. This paper offers a detailed overview on the application of antibiotic prophylaxis in cirrhosis, according to the current evidence.