Upper Gastrointestinal Haemorrhage in Patients with Liver Cirrhosis

Bacterial infections occur in about 20% of patients with cirrhosis with upper gastrointestinal bleeding within 48 hours of admission, another 50% will have an infection during their hospital stay. A Cochrane review of randomised trials indicated that antibiotic prophylaxis reduces the risk of infection and mortality in this patient group.

1st Line

Piperacillin/tazobactam IV 4.5g TDS (N.B. contains a penicillin) whilst NBM converting as soon as able to Co-trimoxazole PO 960mg BD (Reduce dose to 480mg BD if CrCl <30ml/min - N.B.contains a sulphonamide and trimethoprim)
Total duration of antibiotic prophylaxis (IV+PO) is usually 5 days 

Mild penicillin allergy (e.g. rash only)
Cefuroxime IV 1.5g TDS whilst NBM converting to Co-trimoxazole as above.
Total duration of antibiotic prophylaxis (IV+PO) is usually 5 days 

Severe penicillin allergy/allergic to cephalosporins
Discuss with medical microbiologist/gastroenterologist 

Allergic to sulphonamides and/or trimethoprim
Discuss with medical microbiologist/gastroenterologist

The Full Guideline "Antibiotic Guidelines for Adult Patients with Spontaneous Bacterial Peritonitis or Liver Cirrhosis with Upper Gastrointestinal Bleed." is available here. 

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Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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