No difference in outcomes with antibiotics for Child-Pugh A cirrhosis, variceal bleeding
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Researchers reported no difference in rates of infection, rebleeding and mortality when antibiotic prophylaxis was given to stable patients with Child-Pugh A cirrhosis and acute variceal bleeding.
“Acute variceal bleed is a life-threatening, decompensating event in patients with cirrhosis, and bacterial infections can worsen the outcomes and might lead to increased risk of failure to control bleed, early rebleed or mortality,” Anany Gupta, MD, of the department of gastroenterology at All India Institute of Medical Sciences, said at EASL Congress.
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Gupta noted that while prophylactic antibiotics decrease these risks, “further studies are required to establish the role of antibiotics in Child-Pugh A patients, and randomized controlled trials in Child-Pugh A patients are still lacking.”
In a single-center, open-label, randomized controlled trial, Gupta and colleagues assessed the impact of antibiotic prophylaxis in 180 patients (mean age, 45.1 years; 76.9% men) with Child-Pugh A cirrhosis and suspected acute variceal bleeding of predominantly nonviral causes (alcohol, 43.4%; nonalcoholic fatty liver disease, 21.7%).
Patients received either a 5-day course of IV ceftriaxone (n = 90) or no antibiotic (n = 90), and were managed appropriately for variceal bleeding. The primary outcome was incidence of infection on day 5, and secondary outcomes included incidence of early rebleeding and mortality at day 5, as well as new onset decompensation and mortality at 6 weeks.
According to results, infection occurred in 12.3% (95% CI, 6.02-20.8) of patients in the antibiotic prophylaxis arm at day 5 and 7.1% (95% CI, 2.8-15.1) in the no-antibiotic arm, with an absolute risk difference of –4.7% (95% CI, –13.3 to –4). The most common site of infection was spontaneous bacterial peritonitis after early decompensation among patients in both groups (8.6% vs. 3.5%, respectively).
Results also showed comparable incidence of rebleeding (4.9% vs. 0%) and in-hospital mortality (2.5% vs. 0%) at day 5, as well as new-onset decompensation (16% vs. 11.8%) and mortality (2.5% vs. 1.4%) at 6 weeks.
Gupta noted noninferiority could not be established between the two arms.
“Child-A cirrhosis patients presenting to us with acute variceal bleed who are otherwise stable may not require antibiotic prophylaxis and this might avoid the need of antibiotic prophylaxis in Child-A Pugh patients,” he said.
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Gupta A, et al. Abstract GS-006: Randomized controlled trial of ceftriaxone vs. no antibiotic to prevent infection in patients with Child-Pugh A cirrhosis with acute variceal bleeding. Presented at: EASL Congress; June 21-24, 2023; Vienna (hybrid meeting).
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