Background and study aim: Current guidelines recommend antibiotic prophylaxis for all cirrhotic patients with variceal bleeding. However, the low infection rate in Child-A patients raises concerns about antibiotic overuse. This study investigates the impact of antibiotic prophylaxis in this population.
Patients and Methods: We conducted a prospective study of 312 patients with Child-A cirrhosis experiencing their first variceal hemorrhage. Patients received either standard treatment (n=152) or standard treatment plus seven days of intravenous ceftriaxone (n=160). All patients underwent upper endoscopy and band ligation. 
Results: There were no significant differences between groups in baseline characteristics, infection rates, re-bleeding within 5 days, or 6-week mortality. Laboratory markers of infection and liver function were also similar.
Conclusion: Antibiotic prophylaxis did not improve outcomes in Child-A patients with first variceal hemorrhage. This challenges current recommendations and suggests a more nuanced approach to antibiotic use in this population.