Download PDF
CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2022; 12(01): 051-056
DOI: 10.1055/s-0042-1757543
Evidence-Based Commentary

Evidence-Based Commentary: Antibiotics for Prophylaxis of Spontaneous Bacterial Peritonitis

Ifrah Fatima 
1   Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, Missouri, United States
,
Anand V. Kulkarni 
2   Department of Hepatology, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Introduction

Ascites is the major decompensating event in the natural history of cirrhosis.[1] Peritoneal infection is one of the most common sites of infection in cirrhosis.[2] Ascitic fluid infection without any evidence of a surgically treatable intra-abdominal source is termed as spontaneous bacterial peritonitis (SBP).[2] The diagnosis of SBP is established by demonstrating ≥ 250/mm3 polymorphonuclear cells on ascitic fluid analysis (performed with strict aseptic precautions) irrespective of the culture positivity in a cirrhosis patient presenting with or without symptoms of peritoneal infection, that is, fever, abdominal pain, tenderness, diarrhea, or ileus.[3] The prevalence of SBP is approximately 1.2 to 3.5% in outpatients and 10 to 27% in hospitalized patients with cirrhosis.[4] SBP is an indication for liver transplantation as the recurrence rate is as high as 70% at 1 year and is associated with high mortality.[5] Therefore, selective intestinal decontamination (SID) with antibiotics may reduce the incidence of SBP and positively impact the course of cirrhosis patients. In this commentary, we will discuss the indications, advantages, and disadvantages of prophylactic antibiotics to prevent SBP.

Ethical Statement

None.


Author Contributions

I.F.: Initial draft and tables. AVK: Critical revision and figures. Both authors approved final version.


Data Availability Statement

The data associated can be obtained from the corresponding author on reasonable request.


Supplementary Material



Publication History

Received: 21 April 2022

Accepted: 07 June 2022

Article published online:
22 September 2023

© 2022. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kulkarni AV, Kumar P, Sharma M. et al. Pathophysiology and prevention of paracentesis-induced circulatory dysfunction: a concise review. J Clin Transl Hepatol 2020; 8 (01) 42-48
    PubMedSearch in Google Scholar
  • 2 Biggins SW, Angeli P, Garcia-Tsao G. et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 74 (02) 1014-1048
    CrossrefPubMedSearch in Google Scholar
  • 3 Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis–bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 2015; 41 (11) 1116-1131
    CrossrefPubMedSearch in Google Scholar
  • 4 Bonnel AR, Bunchorntavakul C, Reddy KR. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9 (09) 727-738
    CrossrefPubMedSearch in Google Scholar
  • 5 Titó L, Rimola A, Ginès P, Llach J, Arroyo V, Rodés J. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 1988; 8 (01) 27-31
    CrossrefPubMedSearch in Google Scholar
  • 6 Giannelli V, Di Gregorio V, Iebba V. et al. Microbiota and the gut-liver axis: bacterial translocation, inflammation and infection in cirrhosis. World J Gastroenterol 2014; 20 (45) 16795-16810
    CrossrefPubMedSearch in Google Scholar
  • 7 Llach J, Rimola A, Navasa M. et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. Hepatology 1992; 16 (03) 724-727
    CrossrefPubMedSearch in Google Scholar
  • 8 Fernández J, Navasa M, Planas R. et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133 (03) 818-824
    CrossrefPubMedSearch in Google Scholar
  • 9 Moreau R, Elkrief L, Bureau C. et al; NORFLOCIR Trial Investigators. Effects of long-term norfloxacin therapy in patients with advanced cirrhosis. Gastroenterology 2018; 155 (06) 1816-1827.e9
    CrossrefPubMedSearch in Google Scholar
  • 10 Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology 1995; 108 (06) 1828-1834
    CrossrefPubMedSearch in Google Scholar
  • 11 Kulkarni AV, Tirumalle S, Premkumar M. et al. Primary norfloxacin prophylaxis for APASL-defined acute-on-chronic liver failure: a placebo-controlled double-blind randomized trial. Am J Gastroenterol 2022; 117 (04) 607-616
    CrossrefPubMedSearch in Google Scholar
  • 12 Kulkarni AV, Kumar K, Premkumar M, Rao PN, Reddy DN. Response to Mir et al. Am J Gastroenterol 2022; 117 (05) 816
    CrossrefPubMedSearch in Google Scholar
  • 13 Bauer TM, Follo A, Navasa M. et al. Daily norfloxacin is more effective than weekly rufloxacin in prevention of spontaneous bacterial peritonitis recurrence. Dig Dis Sci 2002; 47 (06) 1356-1361
    CrossrefPubMedSearch in Google Scholar
  • 14 Yim HJ, Suh SJ, Jung YK. et al. Daily norfloxacin vs. weekly ciprofloxacin to prevent spontaneous bacterial peritonitis: a randomized controlled trial. Am J Gastroenterol 2018; 113 (08) 1167-1176
    CrossrefPubMedSearch in Google Scholar
  • 15 Kulkarni AV, Rabiee A, Mohanty A. Management of portal hypertension. J Clin Exp Hepatol 2022; 12 (04) 1184-1199
    CrossrefPubMedSearch in Google Scholar
  • 16 Kamal F, Khan MA, Khan Z. et al. Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2017; 29 (10) 1109-1117
    CrossrefPubMedSearch in Google Scholar
  • 17 Praharaj DL, Premkumar M, Roy A. et al. Rifaximin vs. norfloxacin for spontaneous bacterial peritonitis prophylaxis: a randomized controlled trial. J Clin Exp Hepatol 2022; 12 (02) 336-342
    CrossrefPubMedSearch in Google Scholar
  • 18 Mostafa T, Badra G, Abdallah M. The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients. Turk J Gastroenterol 2015; 26 (02) 163-169
    CrossrefPubMedSearch in Google Scholar
  • 19 Komolafe O, Roberts D, Freeman SC. et al. Antibiotic prophylaxis to prevent spontaneous bacterial peritonitis in people with liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev 2020; 1: CD013125
    PubMedSearch in Google Scholar
  • 20 Soni H, Kumar-M P, Sharma V. et al. Antibiotics for prophylaxis of spontaneous bacterial peritonitis: systematic review & Bayesian network meta-analysis. Hepatol Int 2020; 14 (03) 399-413
    CrossrefPubMedSearch in Google Scholar
  • 21 Mücke MM, Mücke VT, Graf C. et al. Efficacy of norfloxacin prophylaxis to prevent spontaneous bacterial peritonitis: a systematic review and meta-analysis. Clin Transl Gastroenterol 2020; 11 (08) e00223
    CrossrefPubMedSearch in Google Scholar
  • 22 Facciorusso A, Papagiouvanni I, Cela M, Buccino VR, Sacco R. Comparative efficacy of long-term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis. Liver Int 2019; 39 (08) 1448-1458
    CrossrefPubMedSearch in Google Scholar
  • 23 Menshawy A, Mattar O, Barssoum K. et al. Safety and efficacy of rifaximin in prophylaxis of spontaneous bacterial peritonitis: a systematic review and meta-analysis. Curr Drug Targets 2019; 20 (04) 380-387
    CrossrefPubMedSearch in Google Scholar
  • 24 Goel A, Rahim U, Nguyen LH, Stave C, Nguyen MH. Systematic review with meta-analysis: rifaximin for the prophylaxis of spontaneous bacterial peritonitis. Aliment Pharmacol Ther 2017; 46 (11-12): 1029-1036
    CrossrefPubMedSearch in Google Scholar
  • 25 Kim T, Hong SI, Park SY. et al. Clinical features and outcomes of spontaneous bacterial peritonitis caused by streptococcus pneumoniae: a matched case-control study. Medicine (Baltimore) 2016; 95 (22) e3796
    CrossrefPubMedSearch in Google Scholar
  • 26 Fernández J, Navasa M, Gómez J. et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35 (01) 140-148
    CrossrefPubMedSearch in Google Scholar
  • 27 Girleanu I, Trifan A, Huiban L. et al. The risk of Clostridioides difficile infection in cirrhotic patients receiving norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis-a real life cohort. Medicina (Kaunas) 2021; 57 (09) 57
    Search in Google Scholar
  • 28 Piano S, Singh V, Caraceni P. et al; International Club of Ascites Global Study Group. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology 2019; 156 (05) 1368-1380.e10
    CrossrefPubMedSearch in Google Scholar
  • 29 Kulkarni AVPM, Premkumar M, Reddy DN, Rao PN. The challenges of ascites management: an Indian perspective. Clin Liver Dis (Hoboken) 2022; 19 (06) 234-238
    CrossrefPubMedSearch in Google Scholar
  • 30 Senzolo M, Cholongitas E, Burra P. et al. Beta-blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int 2009; 29 (08) 1189-1193
    CrossrefPubMedSearch in Google Scholar
  • 31 Motzkus-Feagans C, Pakyz AL, Ratliff SM, Bajaj JS, Lapane KL. Statin use and infections in Veterans with cirrhosis. Aliment Pharmacol Ther 2013; 38 (06) 611-618
    CrossrefPubMedSearch in Google Scholar
  • 32 Kulkarni AV, Anand L, Vyas AK. et al. Omega-3 fatty acid lipid emulsions are safe and effective in reducing endotoxemia and sepsis in acute-on-chronic liver failure: an open-label randomized controlled trial. J Gastroenterol Hepatol 2021; 36 (07) 1953-1961
    CrossrefPubMedSearch in Google Scholar
  • 33 Kulkarni AV, Premkumar M, Arab JP. et al. Early diagnosis and prevention of infections in cirrhosis. Semin Liver Dis 2022; 42 (03) 293-312
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Bajaj JS, Shamsaddini A, Fagan A. et al. Fecal microbiota transplant in cirrhosis reduces gut microbial antibiotic resistance genes: analysis of two trials. Hepatol Commun 2020; 5 (02) 258-271
    CrossrefPubMedSearch in Google Scholar