Prophylactic antibiotics in patients with alcohol‐associated hepatitis receiving steroids: A systematic review and meta‐analysis

Author:

Quek Joo Wei E.1ORCID,Loo Jing Hong2,Jaroenlapnopparat Aunchalee3,Jimenez Cesar45,Al‐Karaghouli Mustafa6,Vargas Victor45,Arab Juan Pablo789,Abraldes Juan G.6,Wong Yu Jun126ORCID

Affiliation:

1. Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

2. Department of Gastroenterology and Hepatology Changi General Hospital Singapore Singapore

3. Department of Medicine Mount Auburn Hospital Boston Massachusetts USA

4. Àrea de malalties digestives Hospital Vall d'Hebron Barcelona Spain

5. Department de Medicina, Facultat de Medicina CIBERehD, Universitat Autònoma de Barcelona Barcelona Spain

6. Liver Unit, Division of Gastroenterology University of Alberta Edmonton Alberta Canada

7. Division of Gastroenterology, Department of Medicine, Schulich School of Medicine Western University & London Health Sciences Centre London Ontario Canada

8. Department of Epidemiology and Biostatistics, Schulich School of Medicine Western University London Ontario Canada

9. Departamento de Gastroenterologia, Escuela de Medicina Pontificia Universidad Catolica de Chile Santiago Chile

Abstract

AbstractBackground & AimsThe benefits of prophylactic antibiotics in patients with alcohol‐associated hepatitis (AH) receiving steroids remain unclear. We aimed to assess the clinical impact of prophylactic antibiotics in AH patients receiving steroids.MethodsWe systematically reviewed four electronic databases from inception to 30 November 2023. Pooled estimates were analysed using random‐effects models. The primary outcome was 90‐day survival. Secondary outcomes included infection at days 30 and 90 days, hepatorenal syndrome (HRS), acute kidney injury (AKI), hepatic encephalopathy (HE) and drug‐related adverse events (AE). Trial sequential analyses were performed for the primary outcome of 90‐day mortality.ResultsWe screened 419 articles and included six eligible studies (four RCTs and two matched cohort studies) with a total of 510 patients. Compared to standard medical treatment (SMT), prophylactic antibiotics were associated with a lower risk of infection at 30 days (OR: 0.35, 95%CI: 0.20–0.59, I 2 = 0%), infection at 90 days (OR: 0.26, 95%CI: 0.10–0.67, I 2 = 0%) and a lower rate of HE (OR: 0.32, 95%CI: 0.12–0.87, I 2 = 0%). However, prophylactic antibiotics did not improve 90‐day survival, sepsis‐related mortality, HRS, or AKI. The risks of drug‐related AE and fungal infections were similar in patients with AH who received prophylactic antibiotics or SMT. Using trial sequential analysis, the minimum sample size required to detect a 15% relative risk reduction in 90 days mortality with prophylactic antibiotics was 1171.ConclusionsIn hospitalized AH patients receiving steroid therapy, prophylactic antibiotics reduced the risk of infection and HE, but did not improve survival or prevent AKI compared to SMT.

Publisher

Wiley

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