Spontaneous bacterial peritonitis secondary prevention: Difference between revisions

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==Secondary Prevention==
==Secondary Prevention==
* 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).
* In one study, 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. 
* Therefore, prophylaxis should be reserved for patients at high risk of developing SBP and daily dosing regimens are preferred. 
* Daily long-term dosing with norfloxacin has been proved to be superior to in-hospital administration of norfloxacin.


* 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>
* 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>


* All cirrhotic patients might benefit from antibiotics if:
<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>
** Ascitic fluid protein <1.0 g/dL<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>. Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.
** Previous SBP<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>
* 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>

Revision as of 18:17, 23 January 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Shivani Chaparala M.B.B.S [3]

Overview

  • After a primary episode of SBP, the recurrence rate at one year is approximately 70%, with a 1-year overall survival rate of 30 to 50% in patients who do not receive antibiotic prophylaxis.
  • Secondary antibiotic prophylaxis in a cirrhotic patient with a prior history of SBP reduces the risk of SBP recurrence from 68% to 20%.
  • Accordingly, most experts recommend daily long-term antimicrobial prophylaxis for patients with a history of one or more episodes of SBP.

Secondary Prevention

  • 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).
  • In one study, 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.
  • Therefore, prophylaxis should be reserved for patients at high risk of developing SBP and daily dosing regimens are preferred.
  • Daily long-term dosing with norfloxacin has been proved to be superior to in-hospital administration of norfloxacin.
  • 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 ). [1][2]

[3][4]

  • 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.[5][6]

References

  1. ↑ http://guideline.gov/content.aspx?id=14887&search=ascitis
  2. ↑ 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.
  3. ↑ Runyon BA (1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology. 91 (6): 1343–6. PMID 3770358.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.


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