The major cause of death in ALF is sepsis accounting for 24–49% of deaths in Indian patient population which is common. Hence we aimed to study the prevalence of sepsis in ALF and the role of prophylactic antibiotics in limiting the incidence of infections in ALF and improving related mortality. Total 46 patients of ALF were divided into 2 main groups with SIRS>=2 and SIRS<2 at the time of admission based on the number of SIRS components. Patients with SIRS>=2 were studied for the prevalence of sepsis in ALF. Group of patients with SIRS<2 were studied for the incidence of sepsis and the role of prophylactic antibiotics in ALF dividing both the groups into further control group who received prophylactic antibiotics and the test group who were treated with antibiotics only on deteriorating due to sepsis and on every episode of worsening. Role of prophylactic antibiotics was studied by documenting serial infections and mortality in control group and comparing with the test group without prophylactic antibiotics.