which antibiotic for cirrhotic GI bleeders?

19 Apr

sensing a theme to end the week?

QUICK POINTS:

ARTICLE 1:

113 patients with advanced liver cirrhosis and active GI hemorrhage.

randomly allocated into either the oral ciprofloxacin or intravenous ceftriaxone group

infections were more frequent in the patients in the oral ciprofloxacin group (P = 0.002)

  • oral ciprofloxacin (34.0%)
  • intravenous ceftriaxone group (14.3%)

 

ARTICLE 2:

epidemiology of bacterial infections in cirrhosis has changed, with a higher incidence of infections caused by quinolone-resistant bacteria.

probability of developing… (norfloxacin vs. ceftriaxone)

  • proved or possible infections (33% vs 11%, P = .003)
  • proved infections (26% vs 11%, P = .03)
  • spontaneous bacteremia or spontaneous bacterial peritonitis (12% vs 2%, P = .03)

infection rate higher in patients receiving norfloxacin 

No difference in hospital mortality was observed between groups.

 

BOTTOM LINE:

more quinolone (e.g. cipro, norfloxacin) resistant bugs out there

ceftriaxone (1 GM IV, for starters in the ED) is a fine choice for cirrhotic GI bleeders

 

 

References: article 1, article 2; picture

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