Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice

Abstract

Patients with cirrhosis show an increased susceptibility to infection due to disease-related immune-dysfunction. Bacterial infection therefore represents a common, often detrimental event in patients with advanced liver disease, since it can worsen portal hypertension and impair the function of hepatic and extra-hepatic organs. Among pharmacological strategies to prevent infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute variceal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. Nevertheless, antibiotic prophylaxis has to deal with the changing bacterial epidemiology in cirrhosis, with increased rates of gram-positive bacteria and multidrug resistant rods, warnings about quinolones-related side effects, and low prescription adherence. Short-term antibiotic prophylaxis is applied in many other settings during hospitalization, such as before interventional or surgical procedures, but often without knowledge of local bacterial epidemiology and without strict adherence to antimicrobial stewardship. This paper offers a detailed overview on the application of antibiotic prophylaxis in cirrhosis, according to the current evidence.

Value of Serum Kidney Injury Molecule-1 in Early Prediction of Kidney Injury in Patient with Ascites and Spontaneous Bacterial Peritonitis

“…Furthermore, the systemic inflammatory condition that occur as a result of increased incidence of infections, such as SBP, further reduce the effective circulatory volume aggravating the renal damage (26) . For this reason, scientists have suggested using prophylactic antimicrobials in patient with liver cirrhosis to reduce the risk for development of infection, thus, protect against renal damage (27) .…”

Antibiotics in Chronic Liver Disease and Their Effects on Gut Microbiota

“…For patients with a history of SBP, long-term prophylaxis with oral norfloxacin or trimethoprimsulfamethoxazole is recommended to prevent recurrence. Additionally, short-term prophylaxis with intravenous antibiotics is advised for cirrhotic patients with gastrointestinal bleeding, as it reduces the risk of infections and improves survival rates [52,53]. Regarding the latter, consensus guidelines recommend the prophylactic use of oral or intravenous antibiotics in this population.…”

Prevalence of Spontaneous Bacteria Peritonitis (SBP) in Hepatitis B (HBV), and Hepatitis C (HCV) Liver Cirrhosis: A Systematic Review and Meta-Analysis

“…The European Association for the Study of Liver (EASL) has established a preventative treatment for SBP in cirrhosis based on therapeutic studies. It is essential to distinguish between the two types of infections (nosocomial and community-acquired) because the source of SBP has a significant impact on the patient's clinical outcomes [8], [12] Previous treatment guidelines recommended amoxicillin or a third-generation cephalosporin; however, both have been therapeutic failures in recent decades due to bacterial resistance and evolution. [3], [13] Although the epidemiological burden, outcome, and related morbidity of SBP in viral cirrhosis are increasing, there is still a need for more information on the pooled prevalence analysis of SBP in patients with HBV-and HCV-related cirrhosis.…”