Clinical

Norfloxacin prevents spontaneous bacterial peritonitis

Last Updated: 2007-10-03 15:37:07 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Primary prophylaxis with norfloxacin prevents spontaneous bacterial peritonitis and improves survival in patients with advanced cirrhosis, Spanish investigators report.

"Cirrhotic patients on the waiting list (for liver transplantation) with poor hepatic and kidney function and without past history of spontaneous bacterial peritonitis could benefit from this treatment," co-investigator Dr. Miquel Navasa from Hospital Clinic Barcelona told Reuters Health.

Dr. Navasa and associates investigated the possible benefits of primary prophylaxis of spontaneous bacterial peritonitis with norfloxacin in 68 advanced cirrhosis patients at high risk of developing spontaneous bacterial peritonitis and hepatorenal syndrome.

Two of 35 patients in the norfloxacin group developed spontaneous bacterial peritonitis, the authors report, compared with 10 of 33 patients in the placebo group. This represented a significantly lower 1-year probability of developing spontaneous bacterial peritonitis in the norfloxacin group, the researcher report in the September issue of Gastroenterology.

Renal failure developed significantly less frequently among norfloxacin patients than among placebo patients, the report indicates, and fewer norfloxacin patients than placebo patients developed hepatorenal syndrome.

Three-month and 1-year survival were significantly higher in the norfloxacin group (94% and 60%, respectively) than in the placebo group (62% and 48%), the researchers note.

"Long-term norfloxacin administration is, therefore, clearly indicated in these patients, particularly if they are awaiting liver transplantation, because it may increase the applicability of this procedure," the authors conclude.

"We should reserve use of selective intestinal decontamination for patients who meet the inclusion criteria of the randomized trials," cautions Dr. Bruce A. Runyon from Loma Linda University Medical Center, California in a related editorial.

"Prolonged exposure to quinolones pretransplant was shown to be a risk factor for posttransplant fungal infections in a prospective study. The risks must be weighed against the benefits when the use of any drug is being considered in patients with advanced cirrhosis," Dr. Runyon concludes.

Gastroenterology 2007;133:818-824,1029-1031.