A French national survey on the use of antibiotic prophylaxis in cirrhotic patients. (10th January 2013)

• Record Type: Journal Article
• Authors: Thevenot, Thierry; Degand, Thibault; Grelat, Natacha; Elkrief, Laure; Christol, Camille; Moreau, Richard; Henrion, Jean; Cadranel, Jean‐François; Sheppard, Frances; Bureau, Christophe; di, Vincent; Pauwels, Arnaud
• Is Part Of: Liver international. Volume 33:Number 3(2013:Mar.)
• Page Start: 389
• Page End: 397
• Publication Date: 2013-01-10
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12093
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" xml:lang="en" id="liv12093-abs-0001"> <title>Summary</title> <sec id="liv12093-sec-0001" sec-type="section"> <title>Background</title> <p>Guidelines recommend antibiotic prophylaxis (AP) in well‐selected groups of cirrhotic patients, but the impact of these recommendations has not been assessed in France.</p> </sec> <sec id="liv12093-sec-0002" sec-type="section"> <title>Aim</title> <p>To evaluate AP prescription tendencies for gastrointestinal bleeding, and primary and secondary prophylaxis of spontaneous bacterial peritonitis (SBP).</p> </sec> <sec id="liv12093-sec-0003" sec-type="section"> <title>Methods</title> <p>Practitioners (<italic>n</italic> = 1, 159) working in general hospitals (GH) or in university hospitals (UH) received a self‐administered questionnaire.</p> </sec> <sec id="liv12093-sec-0004" sec-type="section"> <title>Results</title> <p>Three hundred and eighty‐nine (33.6%; GH 35% and UH 30.4%) practitioners responded. AP was prescribed by 97.7%, 72.3% and 94.8% of practitioners, without significant differences between UH and GH, respectively, for gastrointestinal bleeding (quinolones 48.2%, third‐generation cephalosporins 27.7% and amoxicillin‐clavulanic acid 22.2%), primary (quinolones 97.2%) and secondary prophylaxis of SBP (quinolones 99%). For gastrointestinal bleeding, ofloxacin (47.6%) and norfloxacin (37.4%) were the main quinolones prescribed, and ceftriaxone (77%) was the main third‐generation cephalosporin prescribed. The principal reasons for prescribing AP were a decrease in bacterial infection (88.9% for gastrointestinal bleeding, 91.3% for primary and 94.3% for secondary prophylaxis of SBP), a recommendation by a consensus conference (83%, 38% and 74.4% respectively) and an improvement in survival (72.8%, 41.3% and 57.7% respectively). Only 31.7% of practitioners (39.6% for UH vs. 28.6% for GH;<italic> P</italic> = 0.038) believed that AP may reduce the risk of bleeding recurrence. Reported side effects (28%) of AP mainly concerned the risk of quinolone resistance (62% of cases).</p> </sec> <sec id="liv12093-sec-0005" sec-type="section"> <title>Conclusion</title> <p>Antibiotic prophylaxis is well‐recognized by French practitioners, but its routine use depends on the expertise of practitioners. Quinolones remain the main antibiotic class prescribed irrespective of the type of prophylaxis.</p> </sec> </abstract>