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Cited by 105Liver Disease and TransplantationAntifungal resistance and susceptibilitySepsis Diagnosis and Treatment

Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis

Elfert, Asem, Abo Ali, Lobna, Soliman, Samah, Ibrahim, Shimaa, Abd-Elsalam, Sherief·2016·European Journal of Gastroenterology & Hepatology
DOI 10.1097/meg.0000000000000724
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Abstract

Background and aims: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis with a high recurrence rate and a marked increase in mortality. Norfloxacin is used widely for the secondary prophylaxis of SBP; however, its extensive long-term use has led to an increase in the incidence of quinolone-resistant and Gram-positive SBP. Rifaximin is a nonabsorbable broad-spectrum antibiotic and does not appear to promote emergence of resistance. The aim of this study was to compare the safety and efficacy of rifaximin versus norfloxacin for the secondary prevention of SBP in patients with liver cirrhosis and ascites. Materials and methods: Two hundred and sixty two cirrhotic patients with ascites and a previous episode of SBP were assigned randomly to receive either 1200 mg rifaximin or 400 mg of norfloxacin daily for 6 months. All patients were monitored clinically each month and with ascitic fluid examination at the end of 2 and 6 months if not clinically suspected of recurrence earlier. Results: Recurrence of SBP was significantly lower in the rifaximin group (3.88 vs. 14.13%) compared with the norfloxacin group (P=0.04). The mortality rate was significantly decreased in the rifaximin group (13.74 vs. 24.43%) compared with the norfloxacin group (P=0.044). The causes of death between the two groups did not show a significant difference (P=0.377), but encephalopathy-related deaths were three folds higher in the norfloxacin group. There was a significant decrease in the side effects in the rifaximin group versus the norfloxacin group (P=0.033). Conclusion: Rifaximin was more effective than norfloxacin in the secondary prevention of SBP. Encephalopathy-related mortality and side effects were fewer in the rifaximin group.

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Crossref · 10.1097/meg.0000000000000724

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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 [94]

  • 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 [94]

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Authors
Elfert, A., Abo Ali, L., Soliman, S., Ibrahim, S., & Abd-Elsalam, S.
Affiliations
Tanta University (EG)
Corresponding author
Abd-Elsalam, Sherief
ORCID
Venue
European Journal of Gastroenterology & Hepatology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-12
Volume
28
Issue
12
Pages
1450-1454
ISSN
0954-691X (ISSN-L)
DOI
10.1097/meg.0000000000000724
OpenAlex
W2508264673
Cited by
105
References
13
Citations by year
2026: 9 · 2025: 11 · 2024: 11 · 2023: 12 · 2022: 5 · 2021: 13 · 2020: 12 · 2019: 8 · 2018: 14 · 2017: 10
FWCI
7.71
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Gastroenterology & Hepatology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
rifaximin, norfloxacin, spontaneous bacterial peritonitis, secondary prophylaxis, liver cirrhosis, ascites, mortality, hepatic encephalopathy, quinolone resistance, antibiotic adverse effects
MeSH terms
Rifaximin, Anti-Infective Agents, Anti-Bacterial Agents, Ascites, Bacterial Infections, Cause of Death, Egypt, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Mortality, Norfloxacin, Peritonitis, Rifamycins, Treatment Outcome, Secondary Prevention

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