Antibiotic Prophylaxis in Cirrhosis and Upper Gastrointestinal Bleeding

Abstract This chapter examines the effectiveness of ceftriaxone vs. norfloxacin for bacterial infection prophylaxis in cirrhotic patients with upper gastrointestinal (UGI) bleeding. The underlying study showed that intravenous ceftriaxone prevents infections more effectively than oral norfloxacin, especially in settings with a high prevalence of fluoroquinolone-resistant (FQR) gram-negative bacteria. Patients receiving ceftriaxone experienced significantly lower rates of proven or possible bacterial infections within 10 days compared to those treated with norfloxacin. The chapter emphasizes the increasing resistance to fluoroquinolones and the superior efficacy of ceftriaxone in this population and concludes that ceftriaxone has become the preferred antibiotic for prophylaxis in cirrhotic patients with UGI bleeding, particularly in health care facilities with high levels of FQR Enterobacteriaceae.