[Prospective randomized trial of intravenous ciprofloxacin for prevention of bacterial infection in cirrhotic patients with esophageal variceal bleeding].

Background/aims: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding. The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding.

Methods: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t.

Results: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups.

Conclusions: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.