Parenteral antibiotic prophylaxis of bacterial infections does not improvecost-efficacy of oral norfloxacin in cirrhotic patients with gastrointestinal bleeding

Objective: Selective intestinal decontamination with norfloxacin is useful in the prevention of bacterial infections in cirrhotic patients with gastro intestinal bleeding. However, bleeding cirrhotic patients with ascites, enc ephalopathy, or shock are at high risk to develop bacterial infections in s pite of prophylactic norfloxacin. The aim of this study was to assess wheth er the addition of intravenous ceftriaxone could improve the efficacy of pr ophylaxis with norfloxacin in these patients. Methods: Fifty-six cirrhotic patients with gastrointestinal hemorrhage and ascites, encephalopathy, or s hock were randomized into two groups: Group 1 (n = 28) received oral norflo xacin 400 mg/12 h for 7 days, and group 2 (n = 28) received norfloxacin plu s intravenous ceftriaxone 2 g daily during the first 3 days of admission. R esults: Ten patients were excluded because of community-acquired infection, surgery, or death within the first 24 h. The incidence of bacterial infect ions during hospitalization was 18.1% in group 1 and 12.5% in group 2 (p = NS). The incidence of severe infections (spontaneous bacterial peritonitis, bacteremia, or pneumonia) was also similar in both groups: 9% in group 1 v ersus 8.3% in group 2 (p = NS). There were no statistical differences betwe en the two groups with respect to duration of hospitalization or mortality. The cost of antibiotic therapy (including prophylaxis and treatment of inf ections) was significantly higher in group 2. Conclusion: These results sug gest that the addition of intravenous ceftriaxone during the first 3 days o f hospitalization does not improve the cost-efficacy of oral norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastroin testinal bleeding and high risk of infection. (C) 1998 by Am. Cell. of Gast roenterology.