Effects of Long-term Norfloxacin Therapy in Patients With Advanced Cirrhosis

Moreau, Richard; Elkrief, Laure; Bureau, Christophe; Perarnau, Jean–Marc; Thévenot, Thierry; Saliba, Faouzi; Louvet, Alexandre; Nahon, Pierre; Lannes, Adrien; Anty, Rodolphe; Hillaire, Sophie; Pasquet, Blandine; Ozenne, Violaine; Rudler, Marika; Ollivier-Hourmand, Isabelle; Robic, Marie Angèle; d’Altéroche, Louis; Martino, Vincent Di; Ripault, Marie–Pierre; Pauwels, Arnaud; Grangé, Jean‐Didier; Carbonell, Nicolas; Bronowicki, Jean–Pierre; Payancé, Audrey; Rautou, Pierre‐Emmanuel; Valla, Dominique; Gault, Nathalie; Lebrec, Didier

doi:10.1053/j.gastro.2018.08.026

Cited by 120 publications

(117 citation statements)

References 35 publications

Supporting

Mentioning

107

Contrasting

Unclassified

Order By: Relevance

“…Overall, these 10 trials included 910 patients. Out of 10 RCTs, four compared norfloxacin with placebo (included the study by Novella et al comparing continuous 1‐year norfloxacin treatment versus norfloxacin administered only during hospitalization), two compared ciprofloxacin with placebo, one norfloxacin with ciprofloxacin, one compared norfloxacin with rifaximin, and two compared norfloxacin with trimethoprim/sulfamethoxazole . SBP occurrence was reported in all the included trials, mortality rate was registered in eight RCTs, HRS occurrence in four RCTs …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Comparative efficacy of long‐term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis

Facciorusso

Papagiouvanni

Cela

et al. 2019

Liver International

View full text Add to dashboard Cite

Background & Aims: Several antibiotic treatments aiming to prevent spontaneous bacterial peritonitis (SBP) in cirrhotic patients with low-protein content in ascitic fluid have been tested; however, there are limited data on the comparative efficacy of these regimens. We assessed their comparative efficacy through a network metaanalysis and using GRADE criteria to appraise quality of evidence.Methods: Through literature review through October 2018, we identified 10 randomized controlled trials comparing antibiotic treatments (norfloxacin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifaximin) with each other or placebo. Primary outcome was SBP occurrence, with mortality rate and rate of other infections as secondary outcomes. Results:In comparison with placebo, moderate quality evidence supports the use of norfloxacin and ciprofloxacin in primary prophylaxis of SBP (risk ratio 0.23; 95% CI, 0.09-0.56; P = 0.001 and 0.23; 0.07-0.79; P = 0.02 respectively) while only low quality evidence suggests superiority of rifaximin (risk ratio 0.15; 0.05-0.42). When antimicrobial agents were compared to each other, no significant difference was found.With regard to mortality, moderate quality supports the superiority of norfloxacin over placebo (risk ratio, 0.68; 95% CI, 0.47-0.99; P = 0.04), while ciprofloxacin and rifaximin showed only a non-significant benefit and no significant difference was found in the other comparisons. None of the tested antibiotics proved to significantly decrease the rate of other infections.Conclusions: Norfloxacin appears to have significant benefit both in terms of SBP prevention and mortality; ciprofloxacin represents a valuable option although without a clear survival benefit. Rifaximin shows interesting results but needs to be tested in further trials. K E Y W O R D S cirrhosis, GRADE, liver, norfloxacin | 1449 FACCIORUSSO et Al.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Baseline patient characteristics and prognostic factors were comparably distributed in the active and comparator groups and across different trials. Three RCTs reported the proportion of patients with refractory ascites …”

Section: Resultsmentioning

confidence: 99%

Comparative efficacy of long‐term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis

Facciorusso

Papagiouvanni

Cela

et al. 2019

Liver International

View full text Add to dashboard Cite

show abstract

“…In primary prophylaxis, norfloxacin is recommended when ascites fluid protein level is below 15 g/L in association with severe cirrhosis (Child‐Pugh score ≥9 and total bilirubin level ≥3 mg/dL (51 μmol/L), with either impaired renal function or hyponatraemia) . A French RCT compared norfloxacin to placebo in Child Pugh C patients without previous SBP . Six‐month mortality was only significantly lower in patients with low ascitic fluid protein levels (<15 g/L), confirming that primary prophylaxis should be restricted to the most severe patients.…”

Section: Optimal Management Of Ascitesmentioning

confidence: 99%

Optimal management of ascites

Rudler

Mallet

Sultanik

et al. 2020

Liver International

Self Cite

View full text Add to dashboard Cite

Ascites is the most common complication of cirrhosis, which develops in 5%‐10% of patients per year. Its management is based on symptomatic measures including restriction of sodium intake, diuretics and paracentesis. Underlying liver disease must always be treated and may improve ascites. In some patients, ascites is not controlled by medical therapies and has a major impact on quality of life and survival. TIPS placement and liver transplantation must therefore be discussed. More recently, repeated albumin infusions and Alfapump® have emerged as new therapies in ascites. In this review, the current data on these different options are analysed and an algorithm to help the physician make clinical decisions is suggested.

show abstract

“…In these studies, prevention of infection was the primary outcome, and mortality (or HRS) was a secondary endpoint. Only one recent RCT investigates the effect of oral norfloxacin (versus placebo) on 6‐month survival in patients with decompensated (Child C) cirrhosis . Although there were no differences in overall mortality, survival was greater with norfloxacin in those with an ascites protein level less than 1 g/dL.…”

Section: Do Prophylactic Antibiotics Prevent Infections and The Downsmentioning

confidence: 99%

Prophylactic Antibiotics in Cirrhosis: Are They Promoting or Preventing Infections?

García–Tsao

2019

Clinical Liver Disease

View full text Add to dashboard Cite

show abstract

Effects of Long-term Norfloxacin Therapy in Patients With Advanced Cirrhosis

Cited by 120 publications

References 35 publications

Comparative efficacy of long‐term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis

Comparative efficacy of long‐term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis

Optimal management of ascites

Prophylactic Antibiotics in Cirrhosis: Are They Promoting or Preventing Infections?

Contact Info

Product

Resources

About