Gastrointestinal Hemorrhage Clinical Trial
Official title:
Comparison of 3 Days and 7 Days Intravenous Ceftriaxone Prophylaxis in Patients With Acute Variceal Bleeding
Verified date | January 2009 |
Source | Far Eastern Memorial Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | Taiwan: Department of Health |
Study type | Interventional |
Prophylactic antibiotics have been routinely recommended for cirrhotic patients with upper
gastrointestinal bleeding recently. However, the regimen and duration of its use remain an
inconclusive issue. Quinolones and 3rd generation cephalosporins have been more often used
for prophyalxis recently. The duration for antibiotic usage were variable in the
literatures, ranged from 4-10 days. The latest guideline from AASLD in 2007 was 7 days. In
the survey of infections in cirrhotic patients with UGI bleeding performed by Bernard et al,
most infections occurred in the first 5 days and half within the first 48 hours. Therefore,
considering the cost-effectiveness and drug resistance issues, the necessity for such
prophylaxis for 7 days may need to be re-evaluated.
The purpose of our study is to investigate the antibiotic prophylaxis duration for cirrhotic
patients with acute gastro-esophageal variceal bleeding. We will enroll those patients
suffering from variceal bleeding documented by endoscopic examination and without apparent
evidence of infection. Those who have received antibiotics within 2 weeks, are less than 18
years old, get pregnant, have malignancy other than HCC, have allergy to ceftrioxone are
excluded. After receiving well explanation and giving consent, these patients are randomly
allocated to 2 groups and receive prophylactic antibiotic just after endoscopic examination;
Group I: receiving ceftriaxone 500 mg iv bolus stat and then q12h for 3 days, Group II:
receiving ceftriaxone 500 mg iv bolus stat and then q12h for 7 days. They will receive
appropriate endoscopic treatment for gastro-esophgeal varices and glypressin 1mg q6h for 3
days. They will start to feed on the 2nd day if not contraindicated. The 2nd endoscopic
treatment for varices will be performed 2 weeks later. We record the demographic data, vital
signs, transfusion amount; check hemogram, U/A, CXR, ascites routine (with apparent
ascites), classification of variceal size and Child-Pugh classification. We monitor the
events of rebleeding & infection, transfusion amount and hospitalization days We use
rebleeding rate within 14 days as the primary end point. It is defined as the following
events after initial stabilization of vital signs for 24 hours; (1): recurrence of
hematemesis or bloody stool (2); need of transfusion more than 2 unit of blood and systolic
pressure < 100 mmHg or pulse rate > 100/mn. We use infection rate during admission and
mortality rate within 28 days as secondary end points.
Status | Completed |
Enrollment | 79 |
Est. completion date | April 2013 |
Est. primary completion date | March 2013 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - those patients suffering from variceal bleeding documented by endoscopic examination and without apparent evidence of infection. Exclusion Criteria: - received antibiotics within 2 weeks, less than 18 years old, get pregnant, have malignancy other than HCC, have allergy to ceftrioxone |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Country | Name | City | State |
---|---|---|---|
Taiwan | Far Eastern Memorial Hospital | Taipei |
Lead Sponsor | Collaborator |
---|---|
Far Eastern Memorial Hospital |
Taiwan,
Alonso MJ, Aller MA, Corcuera MT, Nava MP, Gömez F, Angulo A, Arias J. Progressive hepatocytic fatty infiltration in rats with prehepatic portal hypertension. Hepatogastroenterology. 2005 Mar-Apr;52(62):541-6. — View Citation
Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology. 1995 Jun;108(6):1828-34. — View Citation
Bernard B, Grangé JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999 Jun;29(6):1655-61. — View Citation
Bleichner G, Boulanger R, Squara P, Sollet JP, Parent A. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. Br J Surg. 1986 Sep;73(9):724-6. — View Citation
de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005 Jul;43(1):167-76. Erratum in: J Hepatol. 2005 Sep;43(3):547. — View Citation
Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, Rodés J. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 2002 Jan;35(1):140-8. — View Citation
Fernández J, Ruiz del Arbol L, Gómez C, Durandez R, Serradilla R, Guarner C, Planas R, Arroyo V, Navasa M. Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology. 2006 Oct;131(4):1049-56; quiz 1285. — View Citation
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007 Sep;46(3):922-38. Erratum in: Hepatology. 2007 Dec;46(6):2052. — View Citation
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007 Sep;102(9):2086-102. Erratum in: Am J Gastroenterol. 2007 Dec;102(12):2868. — View Citation
Hou MC, Lin HC, Liu TT, Kuo BI, Lee FY, Chang FY, Lee SD. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology. 2004 Mar;39(3):746-53. — View Citation
Husová L, Lata J, Husa P, Senkyrík M, Juránková J, Díte P. Bacterial infection and acute bleeding from upper gastrointestinal tract in patients with liver cirrhosis. Hepatogastroenterology. 2005 Sep-Oct;52(65):1488-90. — View Citation
Jun CH, Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ, Kim YD. Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study. J Korean Med Sci. 2006 Oct;21(5):883-90. — View Citation
Lata J, Juránková J, Husová L, Senkyrík M, Díte P, Dastych M, Príbramská V, Kroupa R. Variceal bleeding in portal hypertension: bacterial infection and comparison of efficacy of intravenous and per-oral application of antibiotics--a randomized trial. Eur J Gastroenterol Hepatol. 2005 Oct;17(10):1105-10. — View Citation
Pohl J, Pollmann K, Sauer P, Ring A, Stremmel W, Schlenker T. Antibiotic prophylaxis after variceal hemorrhage reduces incidence of early rebleeding. Hepatogastroenterology. 2004 Mar-Apr;51(56):541-6. — View Citation
Soriano G, Guarner C, Tomás A, Villanueva C, Torras X, González D, Sainz S, Anguera A, Cussó X, Balanzó J, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology. 1992 Oct;103(4):1267-72. — View Citation
Wilbur K, Sidhu K. Antimicrobial therapy in patients with acute variceal hemorrhage. Can J Gastroenterol. 2005 Oct;19(10):607-11. — View Citation
* Note: There are 16 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | rebleeding rate within 14 days | 14 days | No | |
Secondary | motarlity rate within 28 days | 28 days | No |
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