Soriano G, Guarner C, Tomas A, et al. Norfloxacin prevents ... for GI... · Soriano G, Guarner C,...

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Soriano G, Guarner C, Tomas A, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology 1992;103:1267-1272. Cirrhotic patients who are hospitalized for GI bleeding often have infections such as UTI, SBP, and pneumonia secondary to gram-negative bacilli. In this trial, patients with UGIB underwent EGD with intervention (such as sclerotherapy for esophageal and gastric varices, etc.), and group 1 received norfloxacin post-endoscopy, while group 2 did not. Compared to the control group, the norfloxacin group showed a decreased incidence of overall infection (10% vs. 37.2%, p = 0.001), bacteremia, and/or SBP (3.3% vs. 16.9%, p < 0.05), and UTI (0% vs. 18.6%, p = 0.001). Mortality did not differ in this study, but a subsequent meta-analysis showed decreased mortality with prophylactic antibiotics (Soares-Weiser K, et al. Scandinavian Journal of Gastroenterology 2003;38:193-200). At our institution, piperacillin is often used for gram-negative coverage, and quinolones are less favored given our resistance panel.