Evidence-Based Commentary: Antibiotics for Prophylaxis of Spontaneous Bacterial Peritonitis

Fatima, Ifrah; Kulkarni, Anand V.

doi:10.1055/s-0042-1757543

Cited by 3 publications

(1 citation statement)

References 36 publications

(47 reference statements)

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“…Rifaximin is an excellent antibiotic with coverage against Gram-positive and -negative bacteria (11). It reduces the load of gut-derived toxins, in addition to reducing proinflammatory cytokine levels.…”

Section: Introductionmentioning

confidence: 99%

Antibiotics With or Without Rifaximin for Acute Hepatic Encephalopathy in Critically Ill Patients With Cirrhosis: A Double-Blind, Randomized Controlled (ARiE) Trial

Kulkarni,

Avadhanam,

Karandikar

et al. 2023

Am J Gastroenterol

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Introduction: Critically ill cirrhosis (CIC) patients admitted to the intensive care unit (ICU) are usually on broad-spectrum antibiotics due to suspected infection or as a hospital protocol. It is unclear if additional rifaximin has any synergistic effect with broad-spectrum antibiotics in ICU patients with acute overt hepatic encephalopathy (OHE). Methods: In this double-blind trial, patients with OHE admitted to ICU were randomized to receive antibiotics (ab) alone or antibiotics with rifaximin (ab+r). Resolution (or 2 grade reduction) of HE, time to resolution of HE, in-hospital mortality, nosocomial infection, and changes in endotoxin levels were compared between the two groups. Sub-group analysis of patients with decompensated cirrhosis (DC) and acute-on-chronic liver failure (ACLF) was performed. Results: Baseline characteristics and severity scores were similar among both groups (92 in each group). Carbapenems and cephalosporin with beta-lactamase inhibitors were the most commonly used antibiotics. On Kaplan-Meier analysis 44.6% (41/92; 95% CI, 32-70.5) in antibiotics only arm and 46.7% (43/92; 95%CI, 33.8-63) in antibiotics+rifaximin arm achieved the primary objective (P=0.84).Time to achieve the primary objective (3.65±1.82 days and 4.11±2.01 days; P=0.27) and in-hospital mortality were similar among both groups (62% vs. 50%;P=0.13). Seven percent and 13% in the ab and ab+r groups developed nosocomial infections (P=0.21). Endotoxin levels were unaffected by rifaximin. Rifaximin led to lower in-hospital mortality (HR: 0.39 [95%CI,0.2-0.76]) in patients with DC but not in patients with ACLF (HR: 0.99 [95%CI,0.6-1.63]) due to reduced nosocomial infections. Discussion: Reversal of overt HE in those on antibiotics was comparable to those on antibiotics+rifaximin.

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Section: Introductionmentioning

confidence: 99%