UGIB + Cirrhosis = Antibiotics?

Written by Kevin Stoffer

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Save a life and prevent infection by giving early antibiotics to patients with cirrhosis and upper gastrointestinal bleeding (UGIB).

Why does this matter?
As the 8th leading cause of death, patients with cirrhosis have many reasons to decompensate – UGIB, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS) are just a few. These often roll together and have extremely high mortality. Anything that can be done to improve outcomes in these patients is essential knowledge.

Bleeding cirrhotics get antibiotics – it rhymes so it must be true
This concise summary of a prior Cochrane systematic review of randomized and prospective trials (N = 1,241) looked at prophylactic antibiotics given to cirrhotic patients with UGIB.  The mortality end points in the study ranged from in-hospital to 90 days out-of-hospital.  The infection end points included diagnosed pneumonia, SBP, UTI, and positive blood cultures. The numbers needed to treat (NNT) for mortality (22) and infection (4) are difficult to ignore. These trials did not assess the harms of antibiotics, but it’s hard to argue with numbers like that.  A retrospective study performed in 2015 showed greater benefits of antibiotics with greater severity of disease.

Caring for cirrhotic patients with UGIB can be complicated, but giving antibiotics to these patients is simple.  We do not have any evidence to show that administration of prophylactic antibiotics is harmful to these patients, and based on the NNT from the above trials, this is one thing I can do in the emergency department to save a life.

Source
Prophylactic Antibiotics In Cirrhotic Patients With Upper Gastrointestinal Bleeding. Acad Emerg Med. 2020 Aug 6. doi: 10.1111/acem.14103. Online ahead of print.

Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FI, Soares-Weiser K, Uribe M. Antibioticprophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database SystRev. 2010 Sep 8;(9):CD002907. Review.

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