Antibiotics use in patients with chronic liver disease

Antibiotics are commonly prescribed in patients with chronic liver disease (CLD). However, the use of antibiotics in patients also raises concerns for many physicians, particularly drug choice, eventual dose adjustments, or toxicity in patients with CLD. Therefore, we performed a retrospective review of 70,632 patients with CLD from two large cohorts in the United States and South Korea to analyze the effects of antibiotic use on these patients. Data on antibiotic use in these patients from 2000 to 2020 were collected. These data were compared with patients’ overall survival to explore the impact of antibiotic use on the clinical outcome of patients with CLD. A total of 16 antibiotics were evaluated. All 13 drugs investigated in the Asian cohort were associated with a worse prognosis (p=0.000) except for Neomycin (p=0.123). Furthermore, in the US cohort, highly potent antibiotics mainly used for the treatment of multi-drug resistance organisms, healthcare-acquired or nosocomial infection, e.g. Amphotericin B, Vancomycin, and Imipenem were also associated with a worse prognosis (all p=0.000). In contrast, antibiotics primarily used for mild infections and outpatient treatment, e.g. Ofloxacin, Ciprofloxacin, and Azithromycin (p=0.000), were even associated with a better outcome for the US cohort. Overall, our large real-world data suggest that the need for antibiotics aimed at multi-drug resistance organisms, and healthcare-acquired or nosocomial infection is an indicator for worse outcomes in patients with CLD. Different outcomes associated with the use of antibiotics primarily used for mild and outpatient infections need to be further evaluated.