JAMA Network JAMA Internal Medicine : Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis
Aug 11, 2025
An insightful interview delves into the use of prophylactic antibiotics for cirrhosis patients experiencing upper gastrointestinal bleeding. Recent findings challenge traditional guidelines, revealing no clear mortality benefits and raising concerns about antibiotic resistance. The conversation also highlights advancements in cirrhosis care and the importance of tailored treatment strategies. Experts discuss the complexities of antibiotic effectiveness and the need for further research to refine clinical practices in this area.
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Short Antibiotics Likely Noninferior
- Connor Prosty's meta-analysis found a 97% probability that shorter antibiotic courses are noninferior for all-cause mortality.
- The noninferiority signal was stronger in studies conducted after 2004.
More Infections But No Mortality Drop
- Shorter or no antibiotic durations were associated with more documented infections in the pooled data.
- Connor Prosty noted this infection increase did not translate into a mortality benefit.
Infection Endpoints May Be Overcalled
- Connor Prosty highlighted that routine cultures and imaging in trials can detect colonization, not true infection.
- He warned these methods may over-diagnose infections that don't affect mortality.