Variceal bleeding in Liver Cirrhosis : Bacterial infection and efficacy of intravenous and pre-oral application of antibiotics-a randomized trial

摘要

Objective : To determine the prevalence of bacterial infection in patients admitted to hospital with variceal bleeding in liver cirrhosis in comparison with patients with liver cirrhosis admitted because of another reason. The effect of orally and intravenous administered antibiotic.Method : Bacteriological investigation of blood culture, urine culture, throat smear, perianal smear and ascites (poly-morphonuclear count as well in ascites) was made in 44 cirrhotic patients admitted to hospital with variGeal bleeding and 46 cirrhotic patients admitted because of another reason. Bleeders were treated endoscopically (band ligation) and pharmacologically (injection octriotide 250 microgram bolus and followed by 25 to 50 microgram per hour for 5 days) and were randomly allocated to the treatment with oral norfloxacin (24 patients) or intravenous ampicillin/ sulbactam (20 patients). Early and late mortalities were evaluated.Results : The incidence of infection was high in both groups (61.3% bleeders vs. 54.3% control), but bleeding patients more often had positive blood culture (13.6% vs. 6.5%) and statistically significantly more positive findings in the throat smears (36.5% vs. 17.3%, P=0.04), which gives the evidence of increased pathological colonization in these patients. No difference in survival was seen in patients with per-oral or intravenous administration of antibiotics.Conclusion : Bacterial infection was demonstrated in a high percentage in patients with liver cirrhosis admitted to hospital. The administration of antibiotics is indicated in these patients. Intravenous application is probably of the same efficacy as per-oral administration.