Optimization of antibiotic prophylaxis in patients with mild hepatic insufficiency: a literature review
Keywords:
Mild liver dysfunction, antibiotic prophylaxis, upper gastrointestinal bleeding, spontaneous bacterial peritonitisAbstract
This study examines antibiotic prophylaxis in patients with liver disease, a process that requires carefully weighing the dosage, the choice of drug, the true benefit of preventing infections, and the risks of worsening hepatic function, causing hepatotoxicity, or contributing to antimicrobial resistance. A bibliographic review of 46 sources in Spanish, English, and Portuguese was conducted to characterize the optimization of prophylactic strategies in patients with mild hepatic insufficiency. Current guidelines recommend third-generation cephalosporins such as ceftriaxone or cefotaxime, as well as quinolones like norfloxacin and ciprofloxacin in cases of upper gastrointestinal bleeding, while options such as norfloxacin, rifaximin, or trimethoprim-sulfamethoxazole are considered for preventing spontaneous bacterial peritonitis. Beta-lactams demonstrate strong performance in surgical procedures and may be used at standard doses when hepatic dysfunction is mild. In conclusion, given the high prevalence of liver diseases and the complexity of their management, it is advisable to select antibiotics with low hepatic metabolism and solid scientific evidence in order to avoid antimicrobial resistance, prevent irrational prescribing, and ensure an individualized, multidisciplinary approach for each patient.
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Ahmed, S. K., Hussein, S., Qurbani, K., Ibrahim, R. H., Fareeq, A., Mahmood, K. A., & Mohamed, M. G. (2024). Antimicrobial resistance: Impacts, challenges, and future prospects. Journal of Medicine, Surgery, and Public Health, 2, 100081. https://doi.org/10.1016/j.glmedi.2024.100081
Allison, R., Guraka, A., Shawa, I. T., Tripathi, G., Moritz, W., & Kermanizadeh, A. (2023). Drug induced liver injury – a 2023 update. Journal of Toxicology and Environmental Health, Part B, 26(8), 442–467. https://doi.org/10.1080/10937404.2023.2261848
Antunes, C., Tian, C., & Copelin, E. L. II. (2025). Upper gastrointestinal bleeding. En StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470300/
Biggins, S. W., Angeli, P., Garcia-Tsao, G., Ginès, P., Ling, S. C., Nadim, M. K., Wong, F., & Kim, W. R. (2021). Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 74(2), 1014–1048. https://doi.org/10.1002/hep.31884
Crocombe, D., & O’Brien, A. (2023). Antimicrobial prophylaxis in decompensated cirrhosis: Friend or foe? Hepatology Communications, 7(9), e0228. https://doi.org/10.1097/HC9.0000000000000228
Delgado Ortiz, D. M. (2024). Profilaxis antibiótica en cirugía de reparación de hernia inguinal, revisión sistemática [Tesis de licenciatura, Universidad del Azuay].
Dumonceau, J.-M., Kapral, C., Aabakken, L., Papanikolaou, I. S., Tringali, A., Vanbiervliet, G., Beyna, T., Dinis-Ribeiro, M., Hritz, I., Mariani, A., Paspatis, G., Radaelli, F., Lakhtakia, S., Veitch, A. M., & Van Hooft, J. E. (2020). ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 52(2), 127–149. https://doi.org/10.1055/a-1075-4080
Endale Simegn, A., Yaregal Melesse, D., Belay Bizuneh, Y., & Mekonnen Alemu, W. (2022). Perioperative management of patients with liver disease for non-hepatic surgery: A systematic review. Annals of Medicine and Surgery, 75, 103397. https://doi.org/10.1016/j.amsu.2022.103397
Faust, N., Yamada, A., Haider, H., Komaki, Y., Komaki, F., Micic, D., & Sakuraba, A. (2020). Systemic review and network meta-analysis: Prophylactic antibiotic therapy for spontaneous bacterial peritonitis. World Journal of Hepatology, 12(5), 239–252. https://doi.org/10.4254/wjh.v12.i5.239
Gu, S., Rajendiran, G., Forest, K., Tran, T. C., Denny, J. C., Larson, E. A., & Wilke, R. A. (2023). Drug-induced liver injury with commonly used antibiotics in the All of Us Research Program. Clinical Pharmacology and Therapeutics, 114(2), 404–412. https://doi.org/10.1002/cpt.2930
Joliat, G.-R., Kobayashi, K., Hasegawa, K., Thomson, J.-E., Padbury, R., Scott, M., Brustia, R., Scatton, O., Tran Cao, H. S., Vauthey, J.-N., Dincler, S., Clavien, P.-A., Wigmore, S. J., Demartines, N., & Melloul, E. (2023). Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2022. World Journal of Surgery, 47(1), 11–34. https://doi.org/10.1007/s00268-022-06732-5
Liakina, V. (2023). Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle. World Journal of Clinical Cases, 11(31), 7530–7542. https://doi.org/10.12998/wjcc.v11.i31.7530
Martin, C., & Zieleskiewicz, L. (2020). Profilaxis antibiótica en cirugía. EMC - Anestesia-Reanimación, 46(2), 1–7. https://doi.org/10.1016/S1280-4703(20)43649-7
Martínez-Martínez, L. M., Rosales-Sotomayor, G., Jasso-Baltazar, E. A., Torres-Díaz, J. A., Aguirre-Villarreal, D., Hurtado-Díaz de León, I., Páez-Zayas, V. M., Sánchez-Cedillo, A., Martínez-Vázquez, S. E., Tadeo-Espinoza, H. N., Guerrero-Cabrera, J. P., García-Alanis, M., & García-Juárez, I. (2024). Falla hepática aguda: Manejo actual y pronóstico. Revista de Gastroenterología de México, 89(3), 404–417. https://doi.org/10.1016/j.rgmx.2024.05.005
Mello, P. A., Rocha, B. G., Oliveira, W. N., Mendonça, T. S., & Domingueti, C. P. (2022). Hepatotoxicidade e alterações de exames laboratoriais de avaliação da função hepática por fármacos. Saúde em Foco, 9(2), 3–28. https://doi.org/10.12819/rsf.2022.9.2.1
Miller, A. C., Arakkal, A. T., Sewell, D. K., Segre, A. M., Tholany, J., & Polgreen, P. M. (2023). Comparison of different antibiotics and the risk for community-associated Clostridioides difficile infection: A case–control study. Open Forum Infectious Diseases, 10(8), ofad413. https://doi.org/10.1093/ofid/ofad413
Mistry, R., Moran, S., & Hughes, S. (2023). Dose adjustments of antimicrobials in patients with hepatic impairment. The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/ld/dose-adjustments-of-antimicrobials-in-patients-with-hepatic-impairment
Niño García, J. P. (2023). Principales complicaciones derivadas de insuficiencia hepática determinada por escala de Child-Pugh-Turcotte en el periodo de enero 2021 a enero 2023 en el Hospital General de Pachuca [Tesis de especialización, Universidad Autónoma del Estado de Hidalgo].
Pérez-Hernández, J. L., Juárez-García, F. I., García-Espinosa, I. A., Medina-Ávalos, E. J., & Higuera-De la Tijera, M. de F. (2022). Lesión hepática inducida por fármacos anestésicos. Revista Mexicana de Anestesiología, 45(3), 188–191. https://doi.org/10.35366/105592
Pin, Á. L. P., Imbaquingo, M. S. L., & Santana, I. G. L. (2024). Etiología, epidemiología y análisis clínicos de las diferentes hepatopatías en adultos mayores: Un análisis sistemático. Polo del Conocimiento, 9(10), 2679–2694. https://doi.org/10.23857/pc.v9i10.8291
Shrestha, J., Zahra, F., & Cannady, J. (2025). Antimicrobial stewardship. En StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK572068/
Song, S., Yang, Y., Geng, C., Tang, Z., Wang, C., & Li, X. (2023). Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacterial peritonitis in cirrhosis: A systematic review and meta-analysis. BMC Infectious Diseases, 23(1), 557. https://doi.org/10.1186/s12879-023-08557-6
Steccanella, F., Amoretti, P., Barbieri, M. R., Bellomo, F., & Puzziello, A. (2022). Antibiotic prophylaxis for hepato-biliopancreatic surgery: A systematic review. Antibiotics, 11(2), 194. https://doi.org/10.3390/antibiotics11020194
Tacke, F., Horn, P., Wong, V. W.-S., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., Yki-Järvinen, H., Gastaldelli, A., Vettor, R., Frühbeck, G., & Dicker, D. (2024). EASL–EASD–EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 81(3), 492–542. https://doi.org/10.1016/j.jhep.2024.04.031
Turiño Luque, J. D., Fernández Roldán, M. C., & Turiño Luque, B. (2023). Profilaxis antibiótica en cirugía mayor ambulatoria. Cirugía Andaluza, 34(2), 157–163. https://www.asacirujanos.com/revista/2023/34/2/10
Vidović Juras, D., Škrinjar, I., Križnik, T., Andabak Rogulj, A., Lončar Brzak, B., Gabrić, D., Granić, M., Peroš, K., Šutej, I., & Ivanišević, A. (2024). Antibiotic prophylaxis prior to dental procedures. Dentistry Journal, 12(11), 364. https://doi.org/10.3390/dj12110364
Wang, Z., Hu, H.-S., Zhao, L.-M., Li, Y., & Liu, X.-D. (2024). Effectiveness of prophylactic antibacterial drugs for patients with liver cirrhosis and upper gastrointestinal bleeding: A systematic review and meta-analysis. Frontiers in Pharmacology, 15, 1324848. https://doi.org/10.3389/fphar.2024.1324848
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