Prophylactic Antibiotics in Compensated Liver Cirrhosis
Prophylactic Antibiotics in Compensated Liver Cirrhosis
timely short-term antibiotic prophylaxis is an essential step in the management of these
 patients . Prophylaxis must be instituted as early as variceal hemorrhage is suspected, and
 timely administration has been associated with a reduced re-bleeding rate and lower mortality
 .

 More recently, the American Association for the Study of Liver Diseases (AASLD), the
 Department of Veterans Affairs (VA), and the American Society for Gastrointestinal Endoscopy
 (ASGE) recommended antibiotic prophylaxis in all cirrhotic patients with UGIB, regardless of
 its source (i.e. variceal or non-variceal) or the presence of ascites.
cute variceal bleeding is one of the major causes of death in cirrhotic patients . It is also
 the major cause of upper gastrointestinal (GI) bleeding in cirrhotic patients, accounting for
 70% of cases . Mortality during the first episode is estimated to 15-20% but is higher in
 severe patients (Child Pugh C), at around 30%, whereas it is very low in patients with
 compensated cirrhosis (Child Pugh A).

 Hemorrhage from gastro-esophageal varices is a devastating complication of portal
 hypertension. Although the in-hospital mortality of acute variceal bleeding was up to 40%
 about 20 years ago, it was decreased to about 15-20% in recent years.20 One of the main
 reasons in the decrease of mortality has been ascribed to the alertness of clinicians in the
 treatment and prophylaxis of associated bacterial infections. The prevalence of bacterial
 infections in cirrhotic patients with gastrointestinal hemorrhage has been up to 52%-66%.

 Therefore, timely short-term antibiotic prophylaxis is an essential step in the management of
 these patients. Prophylaxis must be instituted as early as variceal hemorrhage is suspected,
 and timely administration has been associated with a reduced re-bleeding rate and lower
 mortality .

 More recently, the American Association for the Study of Liver Diseases (AASLD), the
 Department of Veterans Affairs (VA), and the American Society for Gastrointestinal Endoscopy
 (ASGE) recommended antibiotic prophylaxis in all cirrhotic patients with UGIB, regardless of
 its source (i.e. variceal or non-variceal) or the presence of ascites.

 The importance of prophylaxis is incontrovertible in patients with advanced cirrhosis,
 whereas in patients with less severe disease, conflicting data have been published. In a
 retrospective study, Child A patients had a low rate of bacterial infection (2%) in the
 absence of antibiotic prophylaxis, and there was no difference in mortality between patients
 on and off antibiotics .

 In contrast, antibiotics were associated with a marked mortality reduction in Child C
 patients. However, more prospective studies are needed to assess whether antibiotic
 prophylaxis can be avoided in Child A patients .

 Thus, this study will be conducted to investigate the necessity of prophylactic antibiotic in
 compensated cirrhotic patients with UGIB and to evaluate its influence on patient outcomes.
Inclusion Criteria:

 -  Child score "A" Cirrhotic patients

 -  Hematemesis and / or melena.

 Exclusion Criteria:

 -  Patient with unsuccessful endoscopic hemostasis

 -  Patients who already have signs of infections (elevation in the body temperature,
 elevation in white blood cells above 10,000 cell/mmᵌ);

 -  Patients with occult infection (defined as positive blood cultures obtained before
 antibiotic prophylaxis)

 -  Patients using antibiotics before endoscopy.

 -  Patients refuse to participate in the study.