In any patient with cirrhosis and acute gastrointestinal bleeding, start short-course prophylactic antibiotics at presentation, before and regardless of endoscopy findings. Antibiotic prophylaxis reduces bacterial infection, rebleeding and mortality in this group, and is a core part of acute variceal-bleed care.
Ceftriaxone is a reasonable default, particularly in advanced cirrhosis or where local quinolone resistance is high, adjusted to local patterns. Give it alongside a vasoactive drug and early endoscopy, and do not wait for a fever or a positive culture to start.
- Start prophylactic antibiotics in every cirrhotic patient with acute GI bleeding.
- They reduce infection, rebleeding and mortality, not just infection.
- Use ceftriaxone as a reasonable default, adjusted to local resistance.
- Give it with a vasoactive drug and early endoscopy; do not wait for fever.
Why it matters
Antibiotic prophylaxis is one of the few measures that lowers mortality in cirrhotic GI bleeding, yet is easily forgotten.
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