Antibiotic prophylaxis in cirrhosis: Good and bad.
Hepatology. 2015 Nov 3;
Authors: Fernández J, Tandon P, Mensa J, Garcia-Tsao G
Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis and strategies to prevent them are essential. The main current strategy is through the use of prophylactic antibiotics targeted at specific subpopulations at high-risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding and low-protein-ascites with an associated poor liver function. Antibiotic prophylaxis not only effectively prevents the development of bacterial infections in all these indications, but also prevents further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated to a clinically relevant and increasing drawback, the development of infections due to multidrug resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis. Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high-risk for infection, the avoidance of antibiotic overuse and early de-escalation policies are key to achieve this balance. Non-antibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis. This article is protected by copyright. All rights reserved.
PMID: 26528864 [PubMed - as supplied by publisher]