1790 February 21, 2014|Volume 20|Issue 7| WJG|www.wjgnet.com Online Submissions: http://www.wjgnet.com/esps/ bpgofice@wjgnet.com doi:10.3748/wjg.v20.i7.1790 World J Gastroenterol 2014 February 21; 20(7): 1790-1796 ISSN 1007-9327 (print) ISSN 2219-2840 (online) © 2014 Baishideng Publishing Group Co., Limited. All rights reserved. BRIEF ARTICLE Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding Yeong Yeh Lee, Hoi-Poh Tee, Sanjiv Mahadeva Yeong Yeh Lee, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kel- antan, Malaysia Hoi-Poh Tee, Department of Internal Medicine, Hospital Tengku Ampuan Afzan, Kuantan 25100, Pahang, Malaysia Sanjiv Mahadeva, Department of Medicine, Faculty of Medi- cine, University of Malaya, Kuala Lumpur 50603, Malaysia Author contributions: All the authors were involved in the de- sign, analysis and writing of manuscript. Correspondence to: Yeong Yeh Lee, MD, PhD, FACP, FRCP, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia. justnleeyy@gmail.com Telephone: +60-9-7676590 Fax: +60-9-7653370 Received: September 18, 2013 Revised: November 11, 2013 Accepted: January 6, 2014 Published online: February 21, 2014 Abstract Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacte- rial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with he- patocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it re- mains debatable whether variceal bleeding results in in- fection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peri- tonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organ- isms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciproloxacin and norloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous ceph- alosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneicial, particularly in high risk patients with advanced cirrhosis. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Antibiotics; Prophylaxis; Cirrhosis; Variceal bleeding; Infection Core tip: Bacterial infections are common in cirrhotics with variceal bleeding and can inluence its outcomes that include early rebleeding, failure to control bleeding and mortality. It remains unsure whether infection or bleeding is the initiating event but prophylactic antibiot- ics have been proven useful. Short term luoroquinolo- nes and cephalosporins are the most studied antibiot- ics, and they are recommended by guidelines in clinical situations that depend on the severity of liver disease and resistance proile. Lee YY, Tee HP, Mahadeva S. Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding. World J Gastroenterol 2014; 20(7): 1790-1796 Available from: URL: http://www. wjgnet.com/1007-9327/full/v20/i7/1790.htm DOI: http://dx.doi. org/10.3748/wjg.v20.i7.1790 INTRODUCTION Upper gastrointestinal (GI) variceal bleeding is associ- ated with significant mortality in cirrhosis. The preva- lence of variceal bleed is known to occur in 20%-50% of patients with cirrhosis, with rebleeding as a signiicant cause of death [1,2] . For the past 30 years, the mortality has improved markedly from intensive use of endoscopic MINIREVIEWS