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Background & Aims: Oral norfloxacin is the standard of therapy inthe prophylaxis of bacterial infections in cirrhotic patients withgastrointestinal hemorrhage. However, during the last years, the epidemiologyof bacterial infections in cirrhosis has changed, with a higher incidence ofinfections caused by quinolone-resistant bacteria. This randomized controlledtrial was aimed to compare oral norfloxacin vs intravenous ceftriaxone in theprophylaxis of bacterial infection in cirrhotic patients with gastrointestinalbleeding. Methods: One hundred eleven patients with advanced cirrhosis (atleast 2 of the following: ascites, severe malnutrition, encephalopathy, orbilirubin >3 mg/dL) and gastrointestinal hemorrhage were randomly treatedwith oral norfloxacin (400 mg twice daily; n = 57) or intravenous ceftriaxone(1 g/day; n = 54) for 7 days. The end point of the trial was the prevention ofbacterial infections within 10 days after inclusion. Results: Clinical datawere comparable between groups. The probability of developing proved orpossible infections, proved infections, and spontaneous bacteremia orspontaneous bacterial peritonitis was significantly higher in patientsreceiving norfloxacin (33% vs 11%, P = .003; 26% vs 11%, P = .03; and 12% vs2%, P = .03, respectively). The type of antibiotic used (norfloxacin),transfusion requirements at inclusion, and failure to control bleeding wereindependent predictors of infection. Seven gram-negative bacilli were isolatedin the norfloxacin group, and 6 were quinolone resistant. Nonenterococcalstreptococci were only isolated in the norfloxacin group. No difference inhospital mortality was observed between groups. Conclusions: Intravenousceftriaxone is more effective than oral norfloxacin in the prophylaxis of bacterialinfections in patients with advanced cirrhosis and hemorrhage. Leggil'articolo Full-textdisponibile per i soci AIGO !!!!