JAMA Intern Med

Shorter antibiotic courses may suffice for cirrhotic upper GI bleeding

August 13, 2025

Study details: This systematic review and Bayesian meta-analysis included 14 randomized trials with 1,322 adult patients with cirrhosis and upper GI bleeding (UGIB), predominantly variceal. Trials compared longer (5–7 days) vs. shorter (2–3 days or none) durations of systemic antibiotic prophylaxis. Study quality was generally low to moderate, with heterogeneous definitions of bacterial infection and no reporting of adverse events.

Results: Shorter durations (including no prophylaxis) had a 97.3% probability of noninferiority to longer durations for all-cause mortality (risk difference [RD], 0.9%; 95% credible interval [CrI], −2.6 to 4.9). Noninferiority for early rebleeding was less certain (73.8% probability; RD, 2.9%; 95% CrI, −4.2 to 10.0). Shorter durations were associated with more study-defined bacterial infections (RD, 15.2%; 95% CrI, 5.0 to 25.9). Probabilities of noninferiority were higher in studies published after 2004.

Clinical impact: These findings challenge the mortality benefit underlying current guideline recommendations for routine antibiotic prophylaxis in cirrhotic UGIB. While prophylactic antibiotics appeared to lower reported infection rates, limitations in how infections were defined raised concerns about potential bias. More rigorous randomized controlled trials are needed to clarify the true benefit and ideal duration of prophylaxis in the context of modern medical procedures.

Source:

Prosty C, et al. (2025, August 11). JAMA Intern Med. Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis: A Systematic Review and Bayesian Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/40788637/