Prophylactic sequential antibiotic therapy for recurrent liver/biliary sepsis.

Area of Science:

• Hepatology
• Infectious Diseases
• Clinical Pharmacology

Background:

• Recurrent liver/biliary sepsis is a rare but serious condition.
• Antibiotics are curative for acute episodes, but managing recurrent sepsis and underlying causes can be challenging.
• Long-term prophylactic strategies are needed for patients with recurrent liver/biliary sepsis.

Purpose of the Study:

• To evaluate the efficacy and safety of prophylactic sequential antibiotic therapy for recurrent liver/biliary sepsis.
• To assess the long-term outcomes in a large cohort of patients receiving this therapy.

Main Methods:

• A retrospective study included 33 adult patients treated with prophylactic sequential antibiotic therapy from 2005 to 2020.
• Therapy involved oral antibiotics targeting digestive bacteria, primarily Gram-negative bacilli.
• The primary endpoint was reducing septic episodes to ≤1 per year, without hospitalization.

Main Results:

• The majority of patients (78.8%) had a history of hepaticojejunostomy.
• First-line therapy with weekly ciprofloxacin was successful long-term in 57.6% of patients (median follow-up: 92 months).
• Overall efficacy across multiple therapy lines reached 84.8% (28/33 patients).

Conclusions:

• Prophylactic sequential antibiotic therapy demonstrates significant success in preventing recurrent liver/biliary sepsis.
• The treatment is well-tolerated and provides a valuable long-term management option.
• This strategy is effective even in complex cases with prolonged follow-up.