Primary Prophylaxis of Spontaneous Bacterial Peritonitis Delays Hepatorenal Syndrome and Improves Survival in Cirrhosis
Open accessAbstract
Background & aims Norfloxacin is highly effective in preventing spontaneous bacterial peritonitis recurrence in cirrhosis, but its role in the primary prevention of this complication is uncertain.Methods Patients with cirrhosis and low protein ascitic levels (<15 g/L) with advanced liver failure (Child-Pugh score > or = 9 points with serum bilirubin level > or = 3 mg/dL) or impaired renal function (serum creatinine level > or = 1.2 mg/dL, blood urea nitrogen level > or = 25 mg/dL, or serum sodium level < or = 130 mEq/L) were included in a randomized controlled trial aimed at comparing norfloxacin (35 patients) vs placebo (33 patients) in the primary prophylaxis of spontaneous bacterial peritonitis. The main end points of the trial were 3-month and 1-year probability of survival. Secondary end points were 1-year probability of development of spontaneous bacterial peritonitis and hepatorenal syndrome.Results Norfloxacin administration reduced the 1-year probability of developing spontaneous bacterial peritonitis (7% vs 61%, P < .001) and hepatorenal syndrome (28% vs 41%, P = .02), and improved the 3-month (94% vs 62%, P = .003) and the 1-year (60% vs 48%, P = .05) probability of survival compared with placebo.Conclusions Primary prophylaxis with norfloxacin has a great impact in the clinical course of patients with advanced cirrhosis. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of hepatorenal syndrome, and improves survival.
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Rifaximin has been reported to increase survival in advanced liver cirrhosis in several small trials.
“Similar to norfloxacin, rifaximin has been noted to increased survival in patients with advanced liver cirrhosis in several small-scale trials92–95.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [92]
Norfloxacin improves 3-month survival in advanced cirrhosis patients.
“Clinical trials in patients with advanced cirrhosis have shown that long-term use of orally administered norfloxacin is safe, produces a marked reduction of gram-negative bacteria in the faecal microbiota109, reduces the 1-year probability of developing spontaneous bacterial peritonitis and hepatorenal syndrome and improves 3-month survival92.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [92]
Norfloxacin reduces the 1-year probability of developing spontaneous bacterial peritonitis and hepatorenal syndrome.
“Clinical trials in patients with advanced cirrhosis have shown that long-term use of orally administered norfloxacin is safe, produces a marked reduction of gram-negative bacteria in the faecal microbiota109, reduces the 1-year probability of developing spontaneous bacterial peritonitis and hepatorenal syndrome and improves 3-month survival92.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [92]
Several small clinical studies suggest that norfloxacin and rifaximin increase survival in patients with liver cirrhosis.
“Moreover, several small-scale clinical studies have suggested that antibiotics such as norfloxacin and rifaximin increase survival in patients with liver cirrhosis92–95.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [92]
Long-term oral norfloxacin is safe in patients with advanced cirrhosis.
“Clinical trials in patients with advanced cirrhosis have shown that long-term use of orally administered norfloxacin is safe, produces a marked reduction of gram-negative bacteria in the faecal microbiota109, reduces the 1-year probability of developing spontaneous bacterial peritonitis and hepatorenal syndrome and improves 3-month survival92.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [92]
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Self-citation
- Authors
- Fernández, J., Navasa, M., Planas, R., Montoliu, S., Monfort, D., Soriano, G., Vila, C., Pardo, A., Quintero, E., Vargas, V., Such, J., Ginès, P., & Arroyo, V.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Hospital Universitari Germans Trias i Pujol (ES)
- Hospital de Sant Pau (ES)
- Hospital Del Mar (ES)
- Hospital Universitario de Canarias (ES)
- Corresponding author
- Navasa, Miquel
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 133
- Issue
- 3
- Pages
- 818-824
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2012746560
- Cited by
- 709
- References
- 36
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 23 · 2023: 37 · 2022: 28 · 2021: 43 · 2020: 39 · 2019: 42 · 2018: 42 · 2017: 37 · 2016: 34 · 2015: 55 · 2014: 48 · 2013: 31 · 2012: 46
- FWCI
- 30.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Keywords
- spontaneous bacterial peritonitis, primary prophylaxis, norfloxacin, hepatorenal syndrome, liver cirrhosis, survival, renal dysfunction, antibiotic prophylaxis
- MeSH terms
- Aged, Anti-Infective Agents, Double-Blind Method, Female, Hepatorenal Syndrome, Humans, Liver Cirrhosis, Male, Middle Aged, Norfloxacin, Peritonitis, Risk Factors, Survival Analysis, Antibiotic Prophylaxis
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