Surgical Endoscopy

, Volume 25, Issue 9, pp 2911–2918 | Cite as

The effects of cefazolin on cirrhotic patients with acute variceal hemorrhage after endoscopic interventions

  • Huang-Wei Xu
  • Jing-Houng Wang
  • Moan-Shane Tsai
  • Keng-Liang Wu
  • Shue-Shian Chiou
  • Chi-Sin Changchien
  • Tsung Hui Hu
  • Sheng-Nan Lu
  • Seng-Kee Chuah



The American Association for the Study of Liver Diseases (AASLD) guidelines recommend that antibiotic prophylaxis should be instituted in any patient with cirrhosis and gastrointestinal hemorrhage, and that oral norfloxacin, intravenous ciprofloxacin, and ceftriaxone are preferable. However, the antimicrobial spectrum of the first generation of cephalosporins (cefazolin) covers a wide range of bacteria species, including community-acquired strains of Escherichia coli and Klebsiella pneumoniae, but their efficacy as prophylactic antibiotics in cirrhotic patients with acute hemorrhage was seldom warranted in the literature. This study aimed to explore the effects of cefazolin on the outcome of cirrhotic patients with acute variceal hemorrhage after endoscopic interventions.


A cross-sectional, retrospective chart review study was conducted on cirrhotic patients with acute variceal hemorrhage who underwent endoscopic procedures in a medical center. Cirrhotic patients who did not receive antibiotics were classified as group A (n = 63) while patients who received intravenous cefazolin 1 g q8 h for 2–7 days were classified as group B (n = 50). The end points were the prevention of infection, length of hospital stay, time of rebleeding, and death.


A total of 113 patients were studied (male/female: 82/31; age: 56.8 ± 13.5 years). The incidence of infection (including proven infections) and bacteremia were significantly lower in group B patients (38.1% vs. 16.0%, P = 0.010; 17.5% vs. 4.0%, P = 0.026; 9.5% vs. 0%, P = 0.033, respectively). The no prophylactic antibiotics treatment was the independent risk factor. There was no significant difference between the two groups with respect to the source of bleeding, type of endoscopic intervention, length of hospital stay, and mortality. Actuarial probability of remaining free of early rebleeding (<7 days) was P = 0.105 by log-rank test for all cirrhosis patients and P = 0.085 for Child-Pugh class A patients.


The use of cefazolin in cirrhotic patients after endoscopic interventions for acute variceal hemorrhage reduced infections. A trend of actuarial probability of remaining free of early rebleeding (<7 days) was observed, especially in Child-Pugh class A patients. This study may be hampered by the small sample size and more large-scale studies are mandatory.


Cefazolin Cirrhosis Variceal hemorrhage Bacterial infections Rebleeding 



Drs. Huang-Wei Xu, Jing-Houng Wang, Moan-Shane Tsai, Keng-Liang Wu, Hue-Shian Chiou, Chi-Sin Changchien, Tsung Hui Hu, Sheng-Nan Lu, and Seng-Kee Chuah have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Huang-Wei Xu
    • 1
  • Jing-Houng Wang
    • 1
  • Moan-Shane Tsai
    • 2
  • Keng-Liang Wu
    • 1
  • Shue-Shian Chiou
    • 1
  • Chi-Sin Changchien
    • 1
  • Tsung Hui Hu
    • 1
  • Sheng-Nan Lu
    • 1
  • Seng-Kee Chuah
    • 1
  1. 1.Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan

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