A 55-year-old man with Child-Pugh B cirrhosis develops massive hematemesis. He is resuscitated and upper GI endoscopy reveals large esophageal varices with active spurting. After endoscopic band ligation and vasoactive therapy, which agent is recommended to prevent bacterial infections in this setting as it reduces mortality?

• A IV pantoprazole infusion
• B Oral rifaximin 550 mg twice daily
• C Fluconazole prophylaxis
• D Ceftriaxone 1g IV daily for 7 days ✓

Explanation

Antibiotic prophylaxis with ceftriaxone (1g IV daily for 7 days) or norfloxacin is strongly recommended in patients with cirrhosis and acute variceal bleeding, as infections (spontaneous bacterial peritonitis, bacteremia) occur in up to 50% of these patients and independently increase mortality. Multiple RCTs and meta-analyses have shown that prophylactic antibiotics reduce bacterial infections, hepatic encephalopathy, and all-cause mortality in this setting. Rifaximin is used for secondary prevention of hepatic encephalopathy, not acute variceal bleeding prophylaxis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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