Antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage: A randomized trial

Objective: To assess the role of antibiotic prophylaxis in the prevention of rebleeding in acute variceal hemorrhage. Materials and Methods: A total of 60 patients who underwent endoscopic therapy for bleeding esophageal varices were randomized into the prophylaxis group and the on‑demand group. Patients in the prophylaxis group received antibiotic prophylaxis using intravenous ofloxacin till the patient resumed oral fluids, followed by oral ofloxacin tablet for a total of 7 days. In the on‑demand group, antibiotics were used only when infection was evident. Patients were monitored for rebleeding and infection during the hospital stay. Results: A total of 30 patients in the prophylaxis group and 26 patients in the on‑demand group were analyzed. The clinical characteristics in both the groups were similar. The Child–Pugh score was around 7 in both the groups. The incidence of infection was 5/30 (16.7%) in the prophylaxis group and 7/26 (26.9%) in the on‑demand group (P = 0.52). The incidence of early rebleeding in the prophylaxis vs. the on‑demand group was 3 vs. 5 (P = 0.69), and the incidence of late rebleeding was 6 vs. 8 (P = 0.48). The differences were not significant. Conclusion: The present study shows a trend toward lower rate of early and late rebleeding, infection rate and mortality in the prophylaxis group; hence, routine use of antibiotics in all such patients may not be necessary. Further studies with a larger sample size and a longer follow‑up period are required to validate the usefulness of antibiotics in these patients.