UMEM Educational Pearls

Category: Critical Care

Title: Antibiotics for Acute Variceal Bleeding

Keywords: esophageal varices, upper gastrointestinal bleeding, antibiotics (PubMed Search)

Posted: 11/20/2007 by Mike Winters, MD (Updated: 10/20/2020)
Click here to contact Mike Winters, MD

A few days ago Dr. Jump and I had a case of an acute variceal hemorrhage.  Dr. Bond already sent out a great pearl earlier in the year highlighting the importance of octreotide in acute variceal bleeding.  In fact, octreotide alone can result in cessation of hemorrhage in up to 80% of patients.  To add onto Dr. Bond's pearl:

  • Don't forget about antibiotics in acute variceal hemorrhage
  • These patients have a relatively high incidence of bacteremia, which leads to worse outcomes
  • Antibiotics have been shown to decrease infection rates and are associated with decreased rebleeding and the need for transfusions
  • A 3rd generation cephalosporin is currently the recommended antibiotic of choice