Ferrarese A, Passigato N, Cusumano C, Gemini S, Tonon A, Dajti E, Marasco G, Ravaioli F, Colecchia A. Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice. World J Hepatol 2021; 13(8): 840-852 [PMID: 34552691 DOI: 10.4254/wjh.v13.i8.840]
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Reader Comments:
I read with great interest the article on Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice by Alberto Ferrarese et al. In this review article , authors have given an overview about the application of antibiotic prophylaxis in patients with cirrhosis according to the current evidence.
Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential.
The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low-protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated with a clinically relevant and increasing drawback, the development of infections due to multidrug-resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis.
Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early deescalation policies are key to achieve this balance; nonantibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis.
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August 30, 2021, 16:52
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Reader Comments:
Read the review with great interest. Authors have discussed in detail regarding antibiotic prophylaxis in both elective as well as emergency procedures and complications of cirrhosis. The CANONIC study has shown infections as the most common precipitant of acute decompensation either alone or in combination leading to Acute-on-chronic Liver Failure. In addition, infections cause acute worsening of portal hypertension leading to increased risk of bleeding, HRS etc. Considering emergence of multi drug resistant infections, judicious use of antibiotics for prophylaxis should be explored. Rifaximin as a non-absorbable antibiotic has been a promising agent in HE with some data favoring use in SBP needs further studies. More studies are needed for secondary prophylaxis in patients with ACLF who had MDR infections to prevent future decompensations, especially when liver transplant is not feasible.
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Thank you very much for your comments.
Reader's ID:
03728059
Submitted on:
August 29, 2021, 08:31
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Reader Comments:
some abbreviations are not included once mentioned e.g. AVB, although VB (variceal bleeding is there), however AVB (whether Acute or Advanced) needed to be shown.
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Thank you very much for your comments.