Consider Antibiotics in the ED for UGI bleeding?

Consider Antibiotics in the ED for UGI bleeding in patients with cirrhosis.

Spontaneous bacterial peritonitis in patients with cirrhosis is associated with increased morbidity and mortality. Aerobic gram-negative organisms and streptococci are the most frequent causes of this infection.

In a recent Cochrane review of 12 treatment trials, empirical oral or parenteral antimicrobial treatment of patients with cirrhosis and UGI bleeding reduced the incidence of bacterial infections and was associated with shortened hospital stays and reduced rates of overall mortality, mortality from bacterial infections, and rebleeding.


No one antibiotic regimen or route of administration was found to be superior. On the basis of these data, 7 days of empirical antibiotics are recommended for patients with ascites and UGI bleeding.

On the basis of these data, patients with UGB and cirrhosis might need a ED dose of cefuroxime and metronidazole. 

(Pinched from

Mayo Clin Proc. 2011 Jul;86(7):686-701.

Cochrane Database Syst Rev. 2010Sep8;(9):CD002907

Hepatology. 2009 Jun;49(6):2087-107.