Letters To The Editor
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World J Gastroenterol. May 14, 2011; 17(18): 2356-2356
Published online May 14, 2011. doi: 10.3748/wjg.v17.i18.2356
Prophylactic antibiotics for variceal hemorrhage: Clostridium difficile infection still can be a risk
Naohiro Okano, Kentaro Iwata
Naohiro Okano, Department of Emergency Medicine, Saitama Red Cross Hospital, Kamiochiai 8-3-33, Chuoku, Saitama, Saitama, 338-8553, Japan
Kentaro Iwata, Division of Infectious Diseases, Kobe University Hospital, 7-5-1 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan
Author contributions: Okano N and Iwata K contributed equally to this work, wrote the paper and read the article critically and made discussion regarding the article.
Correspondence to: Kentaro Iwata, MD, MSc, FACP, FIDSA, Division of Infectious Diseases, Kobe University Hospital, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. kentaroiwata1969@gmail.com
Telephone: +81-78-3826296 Fax: +81-78-3826298
Received: January 6, 2011
Revised: January 29, 2011
Accepted: February 5, 2011
Published online: May 14, 2011


Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.

Key Words: Variceal hemorrhage, Prophylactic antibiotics, Clostridium difficile infection


Brown et al[1] presented a retrospective study regarding prophylactic use of antibiotics in treatment of variceal hemorrhage. The data show that antibiotics appear to improve the survival rate of patients without increasing Clostridium difficile infection (CDI). However, 70.3% of the patients who were given antibiotics received metronidazole, a therapeutic agent against CDI. No apparent increase in CDI may be simply due to the suppression of the organism by metronidazole. As pointed out in the article, currently recommended antibiotic for this purpose is ceftriaxone[2,3], which is known to predispose to CDI[4]. The result of the article should not be interpreted as the currently recommended use of ceftriaxone posing a low risk of CDI.


Peer reviewer: Michael E Zenilman, MD, Clarence and Mary Dennis Professor and Chairman, Department of Surgery, SUNY Downstate Medical Center, Box 40, 450 Clarkson Avenue, Brooklyn, NY 11202, United States

S- Editor Tian L L- Editor Wang XL E- Editor Ma WH

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