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A major cause of morbidity and mortality among patients with cirrhosis, especially decompensated cirrhosis, is the development of bacterial infections. The use of prophylactic antibiotics has led to improved outcomes in select high-risk cirrhotic patients, such as those with poor liver function and associated low protein ascites, upper gastrointestinal bleeding, and a prior episode of spontaneous bacterial peritonitis. However, the increased use of antibiotics in such patients has led to the development of multidrug-resistant organisms.
To balance the drawbacks and benefits of antibiotic prophylaxis, investigators suggest the following strategies, based on a literature review.
Adopt antibiotic stewardship principles in each hospital:
Limit bro…