Aguirre-Villarreal D, García-Juárez I. Navigating the controversy regarding antibiotic prophylaxis in acute variceal bleeding. World J Gastroenterol 2024; 30(18): 2485-2487 [PMID: 38764763 DOI: 10.3748/wjg.v30.i18.2485]
Corresponding Author of This Article
Ignacio García-Juárez, MD, Professor, Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico. ignacio.garciaj@incmnsz.mx
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 14, 2024; 30(18): 2485-2487 Published online May 14, 2024. doi: 10.3748/wjg.v30.i18.2485
Navigating the controversy regarding antibiotic prophylaxis in acute variceal bleeding
David Aguirre-Villarreal, Ignacio García-Juárez
David Aguirre-Villarreal, Ignacio García-Juárez, Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Author contributions: Aguirre-Villarreal D contributed to the conception, drafting, revision and final approval of the study; García-Juárez I contributed to the conception, analysis, critical revisions and final approval of the study; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio García-Juárez, MD, Professor, Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, Mexico City 14080, Mexico. ignacio.garciaj@incmnsz.mx
Received: February 5, 2024 Revised: March 8, 2024 Accepted: April 16, 2024 Published online: May 14, 2024 Processing time: 95 Days and 14.7 Hours
Abstract
Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical guidelines. However, with recent evidence arguing against antibiotic prophylaxis, the role of this intervention has become less clear.
Core Tip: Although antibiotic prophylaxis is currently a part of guideline-directed therapy for patients with cirrhosis and acute variceal bleeding, new and conflicting evidence has challenged this premise. While previous meta-analyses supported prophylaxis, a recent retrospective cohort study by Ichita et al regarding acute esophageal variceal bleeding found no significant differences in mortality, rebleeding, or bacterial peritonitis between prophylaxis and non-prophylaxis groups. A tailored approach that considers underlying liver function, the method of endoscopic treatment, and local antibiotic resistance patterns might be more appropriate.
