Spontaneous bacterial peritonitis secondary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous bacterial peritonitis}} | {{Spontaneous bacterial peritonitis}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{SCh}}{{AY}} | ||
==Overview== | ==Overview== | ||
Following a first episode of [[spontaneous bacterial peritonitis]], the recurrence rate at one year is ~70%, with a 1-year overall [[survival rate]] of 30-50% in patients who do not receive [[antibiotic]] [[prophylaxis]]. [[Cirrhosis|Cirrhotic patients]] with [[ascites]] and a prior history of [[SBP]], receiving [[antibiotic]] [[prophylaxis]] there is a reduction in the risk of recurrence from 68% to 20%. Accordingly, daily long-term [[antimicrobial prophylaxis]] are recommended for patients with a history of one or more episodes of [[SBP]].<ref name="pmid19561863">{{cite journal| author=Alaniz C, Regal RE| title=Spontaneous bacterial peritonitis: a review of treatment options. | journal=P T | year= 2009 | volume= 34 | issue= 4 | pages= 204-10 | pmid=19561863 | doi= | pmc=2697093 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19561863 }} </ref> | |||
==Secondary Prevention== | ==Secondary Prevention== | ||
{| class="wikitable" | |||
* All patients who have survived an episode of SBP should receive long-term prophylaxis with daily [[norfloxacin]] (or [[trimethoprim/sulfamethoxazole]]) because this is the most data-supported indication for long-term outpatient prophylaxis. <ref>http://guideline.gov/content.aspx?id=14887&search=ascitis</ref> | ! colspan="6" |Secondary SBP prophylaxis | ||
|- | |||
!Indications | |||
!Preferred therapy | |||
!Alternative therapy | |||
!Duration of treatment | |||
!Prognosis | |||
!Complications | |||
|- | |||
| | |||
* Previous history of [[SBP]] | |||
| | |||
* [[Norfloxacin]] 400 mg PO daily | |||
| | |||
* [[Sulfamethoxazole-Trimethoprim|Trimethoprim-sulfamethoxazole]] one DS tablet PO daily. | |||
* [[Ciprofloxacin]] 500 mg PO daily. | |||
* [[Levofloxacin]] 250 mg PO daily. | |||
* [[Rifaximin]] | |||
| | |||
* Indefinite, unless [[ascites]] resolves. | |||
| | |||
* Reduction in the recurrence rate of [[SBP]] from 68% to 20%. | |||
| | |||
* Prolonged use of [[antibiotic]] prophylaxis has led to the development of [[gram-negative]] bacterial resistance (to [[fluoroquinolones]] and [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]]), as well as an increased likelihood of developing [[gram-positive]] infections. | |||
|} | |||
Several studies have shown that oral [[norfloxacin]] 400 mg '''daily''' prevents [[spontaneous bacterial peritonitis]] in patients with low-protein [[ascites]] and those with previous history of [[spontaneous bacterial peritonitis]] (SBP). [[Norfloxacin]] reduced SBP recurrence rates from 68% to 20%. | |||
* Alternative regimens that have been studied include [[oral]] double-strength [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]] 5 doses per week or oral [[ciprofloxacin]] 750 mg once a week, but intermittent dosing may lead to resistance. | |||
* In addition, prolonged use of [[Antibiotic|antibiotic prophylaxis]] has led to the development of [[gram-negative]] bacterial [[resistance]] (to [[fluoroquinolones]] and [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]]), as well as an increased likelihood of developing [[gram-positive]] infections. | |||
* Daily long-term dosing with [[norfloxacin]] has been proved to be superior to in-hospital administration of [[norfloxacin]].<ref name="NovellaSola1997">{{cite journal|last1=Novella|first1=M|last2=Sola|first2=R|last3=Soriano|first3=G|last4=Andreu|first4=M|last5=Gana|first5=J|last6=Ortiz|first6=J|last7=Coll|first7=S|last8=Sabat|first8=M|last9=Vila|first9=M C|last10=Guarner|first10=C|last11=Vilardell|first11=F|title=Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin|journal=Hepatology|volume=25|issue=3|year=1997|pages=532–536|issn=0270-9139|doi=10.1002/hep.510250306}}</ref> | |||
* All patients who have survived an episode of SBP should receive long-term prophylaxis with daily [[norfloxacin]] (or [[trimethoprim/sulfamethoxazole]]) because this is the most data-supported indication for long-term outpatient prophylaxis to prevent future episodes ( 40-70% risk of recurrence in 1 year ). <ref>http://guideline.gov/content.aspx?id=14887&search=ascitis</ref><ref name="GinésRimola1990">{{cite journal|last1=Ginés|first1=Pere|last2=Rimola|first2=Antoni|last3=Planas|first3=Ramón|last4=Vargas|first4=Victor|last5=Marco|first5=Francesc|last6=Almela|first6=Manuel|last7=Forne|first7=Montserrat|last8=Miranda|first8=Maria Luisa|last9=Llach|first9=Josep|last10=Salmerón|first10=Joan Manuel|last11=Esteve|first11=Maria|last12=Marques|first12=Josep Maria|last13=de Anta|first13=Maria Teresa Jiménez|last14=Arroyo|first14=Vicente|last15=Rodés|first15=Joan|title=Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Results of a double-blind, placebo-controlled trial|journal=Hepatology|volume=12|issue=4|year=1990|pages=716–724|issn=02709139|doi=10.1002/hep.1840120416}}</ref><ref name="pmid3770358">{{cite journal |author=Runyon BA |title=Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis |journal=Gastroenterology |volume=91 |issue=6 |pages=1343-6 |year=1986 |pmid=3770358 |doi=}}</ref><ref name="pmid9764990">{{cite journal |author=Grangé JD, Roulot D, Pelletier G, ''et al'' |title=Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial |journal=J. Hepatol. |volume=29 |issue=3 |pages=430-6 |year=1998 |pmid=9764990 |doi=}}</ref> | |||
* [[Rifaximin]] was more effective than [[norfloxacin]] in the secondary prevention of [[SBP]] as [[encephalopathy]]-related mortality and side effects were fewer with [[rifaximin]] than [[norfloxacin]].<ref name="ElfertAbo Ali2016">{{cite journal|last1=Elfert|first1=Asem|last2=Abo Ali|first2=Lobna|last3=Soliman|first3=Samah|last4=Ibrahim|first4=Shimaa|last5=Abd-Elsalam|first5=Sherief|title=Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis|journal=European Journal of Gastroenterology & Hepatology|volume=28|issue=12|year=2016|pages=1450–1454|issn=0954-691X|doi=10.1097/MEG.0000000000000724}}</ref><ref name="DongAronsohn2016">{{cite journal|last1=Dong|first1=Tien|last2=Aronsohn|first2=Andrew|last3=Gautham Reddy|first3=K.|last4=Te|first4=Helen S.|title=Rifaximin Decreases the Incidence and Severity of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis|journal=Digestive Diseases and Sciences|volume=61|issue=12|year=2016|pages=3621–3626|issn=0163-2116|doi=10.1007/s10620-016-4313-0}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category: | [[Category:Emergency mdicine]] | ||
[[Category: | [[Category:Disease]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 00:15, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]Ahmed Younes M.B.B.CH [3]
Overview
Following a first episode of spontaneous bacterial peritonitis, the recurrence rate at one year is ~70%, with a 1-year overall survival rate of 30-50% in patients who do not receive antibiotic prophylaxis. Cirrhotic patients with ascites and a prior history of SBP, receiving antibiotic prophylaxis there is a reduction in the risk of recurrence from 68% to 20%. Accordingly, daily long-term antimicrobial prophylaxis are recommended for patients with a history of one or more episodes of SBP.[1]
Secondary Prevention
| Secondary SBP prophylaxis | |||||
|---|---|---|---|---|---|
| Indications | Preferred therapy | Alternative therapy | Duration of treatment | Prognosis | Complications |
|
|
|
|
|
|
Several studies have shown that oral norfloxacin 400 mg daily prevents spontaneous bacterial peritonitis in patients with low-protein ascites and those with previous history of spontaneous bacterial peritonitis (SBP). Norfloxacin reduced SBP recurrence rates from 68% to 20%.
- Alternative regimens that have been studied include oral double-strength trimethoprim-sulfamethoxazole 5 doses per week or oral ciprofloxacin 750 mg once a week, but intermittent dosing may lead to resistance.
- In addition, prolonged use of antibiotic prophylaxis has led to the development of gram-negative bacterial resistance (to fluoroquinolones and trimethoprim-sulfamethoxazole), as well as an increased likelihood of developing gram-positive infections.
- Daily long-term dosing with norfloxacin has been proved to be superior to in-hospital administration of norfloxacin.[2]
- All patients who have survived an episode of SBP should receive long-term prophylaxis with daily norfloxacin (or trimethoprim/sulfamethoxazole) because this is the most data-supported indication for long-term outpatient prophylaxis to prevent future episodes ( 40-70% risk of recurrence in 1 year ). [3][4][5][6]
- Rifaximin was more effective than norfloxacin in the secondary prevention of SBP as encephalopathy-related mortality and side effects were fewer with rifaximin than norfloxacin.[7][8]
References
- ↑ Alaniz C, Regal RE (2009). "Spontaneous bacterial peritonitis: a review of treatment options". P T. 34 (4): 204–10. PMC 2697093. PMID 19561863.
- ↑ Novella, M; Sola, R; Soriano, G; Andreu, M; Gana, J; Ortiz, J; Coll, S; Sabat, M; Vila, M C; Guarner, C; Vilardell, F (1997). "Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin". Hepatology. 25 (3): 532–536. doi:10.1002/hep.510250306. ISSN 0270-9139.
- ↑ http://guideline.gov/content.aspx?id=14887&search=ascitis
- ↑ Ginés, Pere; Rimola, Antoni; Planas, Ramón; Vargas, Victor; Marco, Francesc; Almela, Manuel; Forne, Montserrat; Miranda, Maria Luisa; Llach, Josep; Salmerón, Joan Manuel; Esteve, Maria; Marques, Josep Maria; de Anta, Maria Teresa Jiménez; Arroyo, Vicente; Rodés, Joan (1990). "Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Results of a double-blind, placebo-controlled trial". Hepatology. 12 (4): 716–724. doi:10.1002/hep.1840120416. ISSN 0270-9139.
- ↑ Runyon BA (1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology. 91 (6): 1343–6. PMID 3770358.
- ↑ Grangé JD, Roulot D, Pelletier G; et al. (1998). "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial". J. Hepatol. 29 (3): 430–6. PMID 9764990.
- ↑ Elfert, Asem; Abo Ali, Lobna; Soliman, Samah; Ibrahim, Shimaa; Abd-Elsalam, Sherief (2016). "Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis". European Journal of Gastroenterology & Hepatology. 28 (12): 1450–1454. doi:10.1097/MEG.0000000000000724. ISSN 0954-691X.
- ↑ Dong, Tien; Aronsohn, Andrew; Gautham Reddy, K.; Te, Helen S. (2016). "Rifaximin Decreases the Incidence and Severity of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis". Digestive Diseases and Sciences. 61 (12): 3621–3626. doi:10.1007/s10620-016-4313-0. ISSN 0163-2116.