Bacterial infection is common in patients with cirrhosis who bleed, and it raises the risk of rebleeding and death. Short-course prophylactic antibiotics in this setting reduce infections, rebleeding and mortality, and are recommended by major hepatology guidelines.
Start them at presentation, alongside vasoactive drugs and before endoscopy, rather than waiting for signs of infection. Intravenous ceftriaxone is commonly used in advanced cirrhosis or where quinolone resistance is high, as it is in much of India.
- Give prophylactic antibiotics to every patient with cirrhosis and upper GI bleeding.
- Start at presentation, not after endoscopy.
- Use intravenous ceftriaxone in advanced cirrhosis or high quinolone-resistance settings.
- Continue for a short course, usually up to seven days.
- Combine with vasoactive drugs and endoscopy within 12 hours.
Why it matters
It is one of the few interventions in variceal bleeding with a proven mortality benefit, and it is still sometimes forgotten.
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