Quality statement 6: Prophylactic antibiotic therapy for variceal bleeding

Quality statement

People with suspected or confirmed variceal acute upper gastrointestinal bleeding are given antibiotic therapy at presentation.

Rationale

People with variceal acute upper gastrointestinal bleeding are prone to infection. Infection has adverse effects on renal function and commonly precipitates hepatorenal failure, characterised by oliguria, sodium and fluid retention and death. Early antibiotic therapy reduces these risks.

Quality measures

Structure

Evidence of local arrangements to ensure that people with suspected or confirmed variceal acute upper gastrointestinal bleeding are given antibiotic therapy at presentation.

Data source: Local data collection.

Process

Proportion of people with suspected or confirmed variceal acute upper gastrointestinal bleeding who receive antibiotic therapy at presentation.

Numerator – the number of people in the denominator who receive antibiotic therapy at presentation.

Denominator – the number of people with suspected or confirmed variceal acute upper gastrointestinal bleeding at presentation.

Data source: Local data collection. Contained in NICE audit support for Acute upper gastrointestinal bleeding: variceal (NICE clinical guideline 141).

Outcome

Rates of sepsis in people with suspected or confirmed variceal acute upper gastrointestinal bleeding.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with suspected or confirmed variceal acute upper gastrointestinal bleeding to be given antibiotic therapy at presentation.

Healthcare practitioners give antibiotic therapy at presentation to people with suspected or confirmed variceal acute upper gastrointestinal bleeding.

Commissioners ensure that they commission services that give antibiotic therapy at presentation to people with suspected or confirmed variceal acute upper gastrointestinal bleeding.

What the quality statement means for patients, service users and carers

People with acute upper gastrointestinal bleeding known or suspected to be caused by enlarged veins are given antibiotics when they first see a healthcare professional.

Source guidance

  • Acute upper gastrointestinal bleeding: management (NICE clinical guideline 141), recommendation 1.5.2 (key priority for implementation).