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Karla Soaresweiser - One of the best experts on this subject based on the ideXlab platform.

  • meta analysis Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding an updated cochrane review
    Alimentary Pharmacology & Therapeutics, 2011
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Nahum Mendezsanchez, Christian Gluud, Misael Uribe
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 509–518 Summary Background  Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. Aim  To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. Methods  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Results  Twelve trials (1241 patients) evaluating Antibiotic Prophylaxis against placebo or no Antibiotic Prophylaxis were included. Antibiotic Prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. Conclusions  Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.

  • Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Cochrane Database of Systematic Reviews, 2010
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Misael Uribe
    Abstract:

    Background Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections. Oral Antibiotics, active against enteric bacteria, have been commonly used as Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002. Objectives To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies. Selection criteria Randomised clinical trials comparing different types of Antibiotic Prophylaxis with no intervention, placebo, or another Antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Data collection and analysis Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Main results Twelve trials (1241 patients) evaluated Antibiotic Prophylaxis compared with placebo or no Antibiotic Prophylaxis. All trials were at risk of bias. Antibiotic Prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different Antibiotic regimens. Data could not be combined as each trial used different Antibiotic regimen. None of the examined Antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections. Authors' conclusions Prophylactic Antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of Antibiotic used; thus, no specific Antibiotic can be preferred. Therefore, Antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.

  • Antibiotic Prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites without gastro intestinal bleeding
    Cochrane Database of Systematic Reviews, 2009
    Co-Authors: Matan J Cohen, Tali Sahar, Shmuel Benenson, Eran Elinav, Mayer Brezis, Karla Soaresweiser
    Abstract:

    Background Spontaneous bacterial peritonitis is frequent among cirrhotic patients, associated with significant morbidity and mortality. Selective intestinal decontamination employing Antibiotics is a proposed prophylactic measure. While data regarding this modality among cirrhotic patients with gastrointestinal bleeding exist, there is insufficient data synthesis regarding cirrhotic patients with ascites and no gastrointestinal bleeding. Objectives To assess whether Antibiotic Prophylaxis decreases spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites and no gastrointestinal bleeding. Search methods We identified relevant randomised trials by searching trial registries of The Cochrane Hepato-Biliary Group and The Cochrane Collaboration, medical literature search engines, and reviewing all literature we found on the topic until February 2009. Selection criteria We searched for randomised clinical trials assessing prophylactic treatment among adult cirrhotic patients with ascites and no gastrointestinal bleeding, comparing Antibiotic therapy with no intervention, placebo, or with another Antibiotic regimen. Data collection and analysis Three independent authors searched for and collected the trials and extracted relevant data. Four other independent authors validated the findings and assessed them. The studies were assessed for design, patient and intervention characteristics, and quality. A meta-analysis was performed to estimate measures of association between Antibiotic Prophylaxis and spontaneous bacterial peritonitis or mortality. Main results Nine trials were included in the review. Seven trials, comparing Antibiotics to placebo or no treatment, were meta-analysed. Systematic bias in design or publication is suggested by trial results. The randomisation results suggest that the probability that true randomisation took place in all trials is very small and the report of most trials regarding design was poor. The proportion of participants with spontaneous bacterial peritonitis varied between the trials from 15% to 50%. The calculated relative risks (95% confidence interval) of spontaneous bacterial peritonitis and mortality among patients treated with Antibiotics compared with no treatment/placebo were 0.20 (0.11 to 0.37) and 0.61 (0.43 to 0.87). There were very few reports of adverse events. Authors' conclusions The pooled estimates suggest that Antibiotic Prophylaxis might be prudent among cirrhotic patients with ascites and no gastrointestinal bleeding. However, poor trial methodology and report coupled with findings suggesting systematic bias in publication and design reflect the fragility of these findings. Potential hazard to society and the patients themselves from resistant pathogens should be considered when promoting long-lasting Antibiotic Prophylaxis. It seems that recommending Antibiotic Prophylaxis is still far from being a substantiated prevention strategy. Trials of better design, well reported, and of longer follow-up are greatly needed.

Misael Uribe - One of the best experts on this subject based on the ideXlab platform.

  • meta analysis Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding an updated cochrane review
    Alimentary Pharmacology & Therapeutics, 2011
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Nahum Mendezsanchez, Christian Gluud, Misael Uribe
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 509–518 Summary Background  Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. Aim  To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. Methods  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Results  Twelve trials (1241 patients) evaluating Antibiotic Prophylaxis against placebo or no Antibiotic Prophylaxis were included. Antibiotic Prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. Conclusions  Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.

  • Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Cochrane Database of Systematic Reviews, 2010
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Misael Uribe
    Abstract:

    Background Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections. Oral Antibiotics, active against enteric bacteria, have been commonly used as Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002. Objectives To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies. Selection criteria Randomised clinical trials comparing different types of Antibiotic Prophylaxis with no intervention, placebo, or another Antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Data collection and analysis Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Main results Twelve trials (1241 patients) evaluated Antibiotic Prophylaxis compared with placebo or no Antibiotic Prophylaxis. All trials were at risk of bias. Antibiotic Prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different Antibiotic regimens. Data could not be combined as each trial used different Antibiotic regimen. None of the examined Antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections. Authors' conclusions Prophylactic Antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of Antibiotic used; thus, no specific Antibiotic can be preferred. Therefore, Antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.

Norberto C Chaveztapia - One of the best experts on this subject based on the ideXlab platform.

  • meta analysis Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding an updated cochrane review
    Alimentary Pharmacology & Therapeutics, 2011
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Nahum Mendezsanchez, Christian Gluud, Misael Uribe
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 509–518 Summary Background  Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. Aim  To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. Methods  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Results  Twelve trials (1241 patients) evaluating Antibiotic Prophylaxis against placebo or no Antibiotic Prophylaxis were included. Antibiotic Prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. Conclusions  Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.

  • Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Cochrane Database of Systematic Reviews, 2010
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Misael Uribe
    Abstract:

    Background Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections. Oral Antibiotics, active against enteric bacteria, have been commonly used as Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002. Objectives To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies. Selection criteria Randomised clinical trials comparing different types of Antibiotic Prophylaxis with no intervention, placebo, or another Antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Data collection and analysis Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Main results Twelve trials (1241 patients) evaluated Antibiotic Prophylaxis compared with placebo or no Antibiotic Prophylaxis. All trials were at risk of bias. Antibiotic Prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different Antibiotic regimens. Data could not be combined as each trial used different Antibiotic regimen. None of the examined Antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections. Authors' conclusions Prophylactic Antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of Antibiotic used; thus, no specific Antibiotic can be preferred. Therefore, Antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.

Felix I Tellezavila - One of the best experts on this subject based on the ideXlab platform.

  • meta analysis Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding an updated cochrane review
    Alimentary Pharmacology & Therapeutics, 2011
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Nahum Mendezsanchez, Christian Gluud, Misael Uribe
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 509–518 Summary Background  Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. Aim  To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. Methods  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Results  Twelve trials (1241 patients) evaluating Antibiotic Prophylaxis against placebo or no Antibiotic Prophylaxis were included. Antibiotic Prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. Conclusions  Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.

  • Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Cochrane Database of Systematic Reviews, 2010
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Misael Uribe
    Abstract:

    Background Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections. Oral Antibiotics, active against enteric bacteria, have been commonly used as Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002. Objectives To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies. Selection criteria Randomised clinical trials comparing different types of Antibiotic Prophylaxis with no intervention, placebo, or another Antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Data collection and analysis Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Main results Twelve trials (1241 patients) evaluated Antibiotic Prophylaxis compared with placebo or no Antibiotic Prophylaxis. All trials were at risk of bias. Antibiotic Prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different Antibiotic regimens. Data could not be combined as each trial used different Antibiotic regimen. None of the examined Antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections. Authors' conclusions Prophylactic Antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of Antibiotic used; thus, no specific Antibiotic can be preferred. Therefore, Antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.

Tonatiuh Barrientosgutierrez - One of the best experts on this subject based on the ideXlab platform.

  • meta analysis Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding an updated cochrane review
    Alimentary Pharmacology & Therapeutics, 2011
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Nahum Mendezsanchez, Christian Gluud, Misael Uribe
    Abstract:

    Aliment Pharmacol Ther 2011; 34: 509–518 Summary Background  Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. Aim  To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. Methods  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Results  Twelve trials (1241 patients) evaluating Antibiotic Prophylaxis against placebo or no Antibiotic Prophylaxis were included. Antibiotic Prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results. Conclusions  Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.

  • Antibiotic Prophylaxis for cirrhotic patients with upper gastrointestinal bleeding
    Cochrane Database of Systematic Reviews, 2010
    Co-Authors: Norberto C Chaveztapia, Tonatiuh Barrientosgutierrez, Felix I Tellezavila, Karla Soaresweiser, Misael Uribe
    Abstract:

    Background Bacterial infections are a frequent complication in patients with cirrhosis and upper gastrointestinal bleeding. Antibiotic Prophylaxis seems to decrease the incidence of bacterial infections. Oral Antibiotics, active against enteric bacteria, have been commonly used as Antibiotic Prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding. This is an update of a Cochrane review first published in 2002. Objectives To assess the benefits and harms of Antibiotic Prophylaxis in cirrhotic patients with upper gastrointestinal bleeding. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index EXPANDED until June 2010. In addition, we handsearched the references of all identified studies. Selection criteria Randomised clinical trials comparing different types of Antibiotic Prophylaxis with no intervention, placebo, or another Antibiotic to prevent bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Data collection and analysis Three authors independently assessed trial quality, risk of bias, and extracted data. We contacted study authors for additional information. Association measures were relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Main results Twelve trials (1241 patients) evaluated Antibiotic Prophylaxis compared with placebo or no Antibiotic Prophylaxis. All trials were at risk of bias. Antibiotic Prophylaxis compared with no intervention or placebo was associated with beneficial effects on mortality (RR 0.79, 95% CI 0.63 to 0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19 to 0.97), bacterial infections (RR 0.36, 95% CI 0.27 to 0.49), rebleeding (RR 0.53, 95% CI 0.38 to 0.74), days of hospitalisation (MD -1.91, 95% CI -3.80 to -0.02), bacteraemia (RR 0.25, 95% CI 0.15 to 0.40), pneumonia (RR 0.45, 95% CI 0.27 to 0.75), spontaneous bacterial peritonitis (RR 0.29, 95% CI 0.15 to 0.57), and urinary tract infections (RR 0.23, 95% CI 0.12 to 0.41). No serious adverse events were reported. The trials showed no significant heterogeneity of effects. Another five trials (650 patients) compared different Antibiotic regimens. Data could not be combined as each trial used different Antibiotic regimen. None of the examined Antibiotic regimen was superior to the control regimen regarding mortality or bacterial infections. Authors' conclusions Prophylactic Antibiotic use in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and seems to have reduced all-cause mortality, bacterial infection mortality, rebleeding events, and hospitalisation length. These benefits were observed independently of the type of Antibiotic used; thus, no specific Antibiotic can be preferred. Therefore, Antibiotic selection should be made considering local conditions such as bacterial resistance profile and treatment cost.