Prophylactic Antibiotics in Admitted Cirrhotics

Cirrhosis is associated with a state of immune-compromise and progressive decompensation, acute on chronic liver failure (ACLF), and death are often caused by bacterial infections. Different sub-groups of patients with cirrhosis at increased risk, i.e. active upper gastrointestinal hemorrhage, low protein ascites, history of spontaneous bacterial peritonitis (SBP), are known to benefit from prophylactic antibiotics. The investigators hypothesize that hospitalized patients with advanced cirrhosis are also at increased risk and thus may benefit from preventive treatment. Subjects will be randomly assigned to receive an antibiotic vs placebo.

Inclusion criteria

• MELD-Na >= 18
• Cirrhosis as defined by liver biopsy or a composite assessment of available results from imaging, elastography, prior records, and laboratory studies

Exclusion criteria

• Inability to obtain consent (from subject or next of kin/legal authorized representative (LAR)
• Allergy to cephalosporins
• Pregnancy (due to limited prospective data regarding safety of ceftriaxone)
• Existing indication for new antibiotics, e.g. upper gastrointestinal hemorrhage or apparent infection
• Use of major immunosuppressive medications (e.g. prednisone 20 mg/day or greater, immunosuppression for solid organ transplant)
• H/o recurrent C difficile infection within the past year (>2) or requiring fecal microbiota transplant (FMT)
• Enrollment in the study protocol during a previous admission