Antibiotic prophylaxis vs. on‑demand antibiotic treatment in endoscopic therapy for variceal hemorrhage: A meta‑analysis of randomized controlled trials

Tao,Zhang; Pu,Wenfeng; Guo,Yuhong; Zhang,Yan; Tang,Xiaobo; Hou,Ying; Hu,Dan; Chen,Jian; Yang,Juan; Du,Zhonghan; Li,Siqing; Feng,Shenggang

doi:10.3892/etm.2024.12629

Antibiotic prophylaxis vs. on‑demand antibiotic treatment in endoscopic therapy for variceal hemorrhage: A meta‑analysis of randomized controlled trials

Authors:
- Zhang Tao
- Wenfeng Pu
- Yuhong Guo
- Yan Zhang
- Xiaobo Tang
- Ying Hou
- Dan Hu
- Jian Chen
- Juan Yang
- Zhonghan Du
- Siqing Li
- Shenggang Feng
View Affiliations

Affiliations: Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
Published online on: June 28, 2024 https://doi.org/10.3892/etm.2024.12629
Article Number: 340
Copyright: © Tao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to conduct a meta‑analysis for elucidating the effects of antibiotic prophylaxis on infection, rebleeding and mortality in patients who underwent endoscopic therapy for variceal hemorrhage. Articles on antibiotic prophylaxis and on‑demand antibiotic administration following endoscopic therapy for acute variceal bleeding were searched on PubMed, Embase and Cochrane Library between January 1959 and February 2024, to elucidate whether the use of prophylactic antibiotics was necessary. The quality of randomized controlled trials (RCTs) was assessed using the Cochrane risk‑of‑bias assessment tool and RevMan software version 5.4.1 was used for meta‑analysis of the data. The current meta‑analysis included four RCTs and 322 patients with acute variceal bleeding who underwent endoscopic therapy. All included studies were of high quality according to the Cochrane risk‑of‑bias assessment tool. According to the results of the meta‑analysis, the incidence of infection in the prophylactic antibiotic group was significantly lower than that in the on‑demand group [odds ratio (OR), 0.31; 95% confidence interval (CI), 0.13‑0.74; P=0.009]. The prophylactic antibiotic group also exhibited a lower incidence of rebleeding compared with that of the on‑demand group (OR, 0.37; 95% CI, 0.19‑0.72; P=0.003). No significant differences were noted in the incidence of mortality between the two groups (OR, 0.92; 95% CI, 0.45‑1.92; P=0.83). In conclusion, the data indicated that antibiotic prophylaxis is recommended to be used in patients who have undergone endoscopic therapy for variceal hemorrhage.

View Figures

View References

1	van Leerdam ME: Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 22:209–224. 2008.PubMed/NCBI View Article : Google Scholar
2	Carneiro de Moura M, Chen S, Kamath BM, Ng VL and Ling SC: Acute variceal bleeding causes significant morbidity. J Pediatr Gastroenterol Nutr. 67:371–376. 2018.PubMed/NCBI View Article : Google Scholar
3	Tayyem O, Bilal M, Samuel R and Merwat SK: Evaluation and management of variceal bleeding. Dis Mon. 64:312–320. 2018.PubMed/NCBI View Article : Google Scholar
4	Hsu YC, Chung CS and Wang HP: Application of endoscopy in improving survival of cirrhotic patients with acute variceal hemorrhage. Int J Hepatol. 2011(893973)2011.PubMed/NCBI View Article : Google Scholar
5	García-Pagán JC, Reverter E, Abraldes JG and Bosch J: Acute variceal bleeding. Semin Respir Crit Care Med. 33:46–54. 2012.PubMed/NCBI View Article : Google Scholar
6	Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, Luk SWY, Wong SH, Lau LHS, Lui RN, et al: Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 382:1299–1308. 2020.PubMed/NCBI View Article : Google Scholar
7	Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, Austin A, Ferguson JW, Olliff SP, Hudson M, et al: U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 64:1680–1704. 2015.PubMed/NCBI View Article : Google Scholar
8	Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M and Zuckerman M: Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: A systematic review and meta-analysis. Endosc Int Open. 3:E409–E417. 2015.PubMed/NCBI View Article : Google Scholar
9	Zuckerman MJ, Jia Y, Hernandez JA, Kolli VR, Norte A, Amin H, Casner NA, Dwivedi A and Ho H: A prospective randomized study on the risk of bacteremia in banding versus sclerotherapy of esophageal varices. Front Med (Lausanne). 3(16)2016.PubMed/NCBI View Article : Google Scholar
10	Galperine T, Flateau C, Venon MD, Lescure FX, Béraud G, Said Ibrahim T, Delisle F, Durand F, Faure K, Pialoux G and Guery B: Recurrent bacteremia, a complication of cyanoacrylate injection for variceal bleeding: Report of two cases and review of the literature. Case Rep Med. 2009(407053)2009.PubMed/NCBI View Article : Google Scholar
11	Randi BA, Ninomiya DA, Nicodemo EL, Lopes BC, Cançado ER and Levin AS: Recurrent bacteremia after injection of N-butyl-2-cyanoacrylate for treatment of bleeding gastric varices: A case report and review of the literature. BMC Res Notes. 8(692)2015.PubMed/NCBI View Article : Google Scholar
12	Hou MC, Lin HC, Liu TT, Kuo BI, Lee FY, Chang FY and Lee SD: Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: A randomized trial. Hepatology. 39:746–753. 2004.PubMed/NCBI View Article : Google Scholar
13	Liu C, Ma L, Wang J, Li F, Tseng Y, Luo T, Zeng X and Chen S: Prophylactic use of antibiotics in endoscopic injection of tissue adhesive for the elective treatment of gastric varices: A randomized controlled study. J Gastroenterol Hepatol. 32:1486–1491. 2019.PubMed/NCBI View Article : Google Scholar
14	Agarwal A, Kumar SS, Sadasivan J and Kate V: Antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage: A randomized trial. J Pharmacol Pharmacother. 6:24–29. 2015.PubMed/NCBI View Article : Google Scholar
15	Selby WS, Norton ID, Pokorny CS and Benn RA: Bacteremia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous cefotaxime: A randomized trial. Gastrointest Endosc. 40:680–684. 1994.PubMed/NCBI
16	Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, et al: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 343(d5928)2011.PubMed/NCBI View Article : Google Scholar
17	Higgins JP and Green S: Cochrane handbook for systematic reviews of interventions version 5.0.0. Naunyn-Schmiedebergs Archiv Exp Pathol Pharmackol. 5(S38)2009.
18	Bowden J, Tierney JF, Copas AJ and Burdett S: Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol. 11(41)2011.PubMed/NCBI View Article : Google Scholar
19	Palma Pérez S and Delgado Rodríguez M: Practical considerations on detection of publication bias. Gac Sanit. 20 (Suppl 3):S10–S16. 2006.PubMed/NCBI View Article : Google Scholar : (In Spanish).
20	Zanetto A and Garcia-Tsao G: Management of acute variceal hemorrhage. F1000Res. 8(F1000)2019.PubMed/NCBI View Article : Google Scholar
21	Alqahtani SA and Jang S: Pathophysiology and management of variceal bleeding. Drugs. 81:647–667. 2021.PubMed/NCBI View Article : Google Scholar
22	Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG and Poupon R: Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 40:652–659. 2004.PubMed/NCBI View Article : Google Scholar
23	O'Brien J, Triantos C and Burroughs AK: Management of varices in patients with cirrhosis. Nat Rev Gastroenterol Hepatol. 10:402–412. 2013.PubMed/NCBI View Article : Google Scholar
24	Vuachet D, Cervoni JP, Vuitton L, Weil D, Dritsas S, Dussaucy A, Koch S, Di Martino V and Thevenot T: Improved survival of cirrhotic patients with variceal bleeding over the decade 2000-2010. Clin Res Hepatol Gastroenterol. 39:59–67. 2015.PubMed/NCBI View Article : Google Scholar
25	Hou MC, Lin HC, Kuo BI, Chen CH, Lee FY and Lee SD: Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: A prospective randomized trial. Hepatology. 21:1517–1522. 1995.PubMed/NCBI
26	Dai C, Liu WX, Jiang M and Sun MJ: Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: A meta-analysis. World J Gastroenterol. 21:2534–2541. 2015.PubMed/NCBI View Article : Google Scholar
27	Lo GH, Lai KH, Cheng JS, Chen MH and Chiang HT: A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 33:1060–1064. 2001.PubMed/NCBI View Article : Google Scholar
28	Moon AM, Dominitz JA, Ioannou GN, Lowy E and Beste LA: Use of antibiotics among patients with cirrhosis and upper gastrointestinal bleeding is associated with reduced mortality. Clin Gastroenterol Hepatol. 14:1629–1637.e1. 2016.PubMed/NCBI View Article : Google Scholar
29	Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications. Clin Mol Hepatol. 26:83–127. 2020.PubMed/NCBI View Article : Google Scholar
30	Gralnek IM, Camus Duboc M, Garcia-Pagan JC, Fuccio L, Karstensen JG, Hucl T, Jovanovic I, Awadie H, Hernandez-Gea V, Tantau M, et al: Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European society of gastrointestinal endoscopy (ESGE) guideline. Endoscopy. 54:1094–1120. 2022.PubMed/NCBI View Article : Google Scholar
31	Lee S, Saxinger L, Ma M, Prado V, Fernández J, Kumar D, Gonzalez-Abraldes J, Keough A, Bastiampillai R, Carbonneau M, et al: Bacterial infections in acute variceal hemorrhage despite antibiotics-a multicenter study of predictors and clinical impact. United European Gastroenterol J. 5:1090–1099. 2017.PubMed/NCBI View Article : Google Scholar
32	Ueno M, Fujiwara T, Tokumasu H, Mano T, Kayahara T, Takabatake H, Morimoto Y, Matsueda K, Fukuoka T and Mizuno M: Real-world efficacy of antibiotic prophylaxis for upper gastrointestinal bleeding in cirrhotic patients in Japan. J Gastroenterol. 58:766–777. 2023.PubMed/NCBI View Article : Google Scholar
33	Lee SW, Lee TY, Chang CS, Ko CW, Yeh HZ and Yang SS: Independent factors associated with early outcome in Chinese cirrhotic patients after cessation of initial esophageal variceal hemorrhage. J Clin Gastroenterol. 44:e123–e127. 2010.PubMed/NCBI View Article : Google Scholar
34	Wu CK, Wang JH, Lee CH, Wu KL, Tai WC, Lu SN, Hu TH and Chuah SK: The outcome of prophylactic intravenous cefazolin and ceftriaxone in cirrhotic patients at different clinical stages of disease after endoscopic interventions for acute variceal hemorrhage. PLoS One. 8(e61666)2013.PubMed/NCBI View Article : Google Scholar
35	Lee J, Xu H, Chuah SK, et al: The effect of intravenous cefazolin and ceftrixions as prophylactic antibiotics in cirrhotic patients with acute variceal hemorrhage after endoscopic interventions-A preliminary report. Hepatol Int. 6(302)2012.