Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Core Tip

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.