JAMA Internal Medicine Author Interviews Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis
Aug 11, 2025
This discussion dives into the impact of prophylactic antibiotics on cirrhosis patients suffering from upper gastrointestinal bleeding. Key findings reveal a lack of clear mortality benefits and the rising threat of antibiotic resistance. The speakers also highlight the need for advanced treatments and reassessing past trials in light of current medical practices. They emphasize differentiating between compensated and decompensated cirrhosis while calling for more research to refine antibiotic protocols for these patients.
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Antibiotics Carry Significant Risks
- Antibiotics are not benign and expose patients to multidrug-resistant colonization and adverse events.
- Connor Prosty argues changes in cirrhosis care warrant reevaluating universal prophylaxis.
Shorter Courses Likely Noninferior For Mortality
- The meta-analysis found a 97% probability that shorter versus longer prophylactic antibiotics were noninferior for all-cause mortality.
- Connor Prosty reports this noninferiority is stronger in studies conducted after 2004.
Reported Infections May Be Overdiagnosed
- Trials used routine cultures and imaging that cannot reliably distinguish colonization from true infection.
- Connor Prosty warns this may inflate reported infection rates that do not translate into mortality differences.