Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites

Sandhu, Bimaljit S.; Gupta, Rajesh; Sharma, Jayant; Singh, Jagdeep; Murthy, N S; Sarin, Shiv Kumar

doi:10.1111/j.1440-1746.2005.03796.x

Cited by 39 publications

(24 citation statements)

References 28 publications

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“…Studies have shown that therapy with prokinetics, with or without antibiotics, in patients with cirrhosis leads to improved small bowel motility and reduced risk of SBP [34][35][36]. There are no studies so far on the role of prophylactic antibiotic therapy in cirrhotic patients with SIBO.…”

Section: Discussionmentioning

confidence: 96%

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

et al. 2009

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Spontaneous bacterial peritonitis (SBP), a common complication of cirrhosis of liver, might result from translocation of bacteria from the small bowel. However, there is scanty data on frequency of small intestinal bacterial overgrowth (SIBO) in patients with cirrhosis of the liver. There are no data on SIBO in patients with extra-hepatic portal venous obstruction (EHPVO) in the literature. A total of 174 patients with cirrhosis of the liver, 28 with EHPVO and 51 healthy controls were studied for SIBO using glucose hydrogen breath test (GHBT). Persistent rise in breath hydrogen 12 ppm above basal (at least two readings) was considered diagnostic of SIBO. Of 174 patients (age 47.2 +/- 11.9 years, 80.5% male) with cirrhosis due to various causes, 67 (38.5%) were in Child's class A, 70 (40.2%) class B and 37 (21.7%) class C. Of the 174 patients with cirrhosis, 42 (24.14%) had SIBO as compared to 1 of 51 (1.9%) healthy controls (P < 0.0001). Patients with EHPVO had similar frequency of SIBO compared to healthy controls [2/28 (7.14%) vs 1/51 (1.97%), P = ns]. Frequency of SIBO in Child's A, B and C was comparable [13 (18.6%) vs 16 (23.9%) and 13 (35.1%), respectively; P = ns]. Presence of SIBO were not related to ascites, etiology of cirrhosis, and degree of liver dysfunction. SIBO is common in patients with cirrhosis of the liver. Patients with EHPVO do not have higher frequency of SIBO than healthy subjects. SIBO in cirrhosis is not related to the degree of derangement in liver function or of portal hypertension.

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Section: Discussionmentioning

confidence: 96%

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

et al. 2009

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“…Although the reasons for prescription were not described in detail, these symptoms might be related to the use of gastric acid suppressants and/or prokinetic drugs. Previous studies have shown an association between gastrointestinal dysmotility and spontaneous bacterial peritonitis in patients with LC [13][14][15][16] . Therefore, we investigated the effects of prokinetics on PDrelated peritonitis, and our data showed that prokinetic use was not associated with a reduced risk of PD-related peritonitis.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, many patients with end-stage renal disease (ESRD) experience gastroparesis or reduced bowel movements, and several studies have identified an association between gastrointestinal dysmotility and spontaneous bacterial peritonitis in cirrhotic patients and animal models of liver cirrhosis (LC). Indeed, decreased intestinal motility and extended transit time can lead to bacterial overgrowth and bacterial translocation from the gastrointestinal tract [13][14][15][16] . However, no study has clarified the effects of prokinetics on PD-related peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

Kwon

Koh

Chun

et al. 2014

WJG

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AIM:To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis (PD) patients. METHODS:This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) to patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms. RESULTS:Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker (H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis (EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients. CONCLUSION:The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Proton pump inhibitors; Histamine 2 receptor antagonists; Gastrointestinal motility; Peritoneal dialysis; PeritonitisCore tip: Bacterial overgrowth/proliferation in an intraluminal environment with a high pH is a well-recognized mechanism for peritonitis development, especially in liver cirrhosis patients. Several studies have investigated whether this mechanism causes peritoneal dialysis (PD)-related peritonitis, although conflicting results have been obtained for the association between acid suppressive therapy and PD-related peritonitis. In addition, no study was conducted to evaluate the association between prokinetics and PD-related peritonitis. Therefore, we sought to assess the effect of gastric acid suppressants and prokinetics on PD-related peritonitis. In the present study, H2B use, but not proton pump inhibitor use, was identified as an independent risk factor for PD-related peritonitis development. RETROSPECTIVE STUDYKwon JE, Koh SJ, Chun J, Kim JW, Kim BG, Lee KL, Im JP, Kim JS, Jung HC. Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis. World J Gastroenterol 2014; 20(25): 8187-8194 Available from: URL:

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“…Selective intestinal decontamination with antibiotics reduces bacterial translocation [28] and decreases the risk of infections, especially those due to Gram negative bacteria [38,39]. Moreover, the addition of cisapride (a prokinetic agent) to norfloxacin has been reported to further decrease the incidence of SBP in cirrhotic patients with ascites [40]. This again supports the role of intestinal bacteria as a major infective source in cirrhotics and may explain why prophylactic antibiotics both orally and intravenously are so effective in reducing infections during variceal bleeding [41].…”

Section: Discussionmentioning

confidence: 97%

Altered intestinal function precedes the appearance of bacterial DNA in serum and ascites in patients with cirrhosis: a pilot study

Thalheimer¹,

Iorio²,

Capra³

et al. 2010

European Journal of Gastroenterology & Hepatology

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Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites

Cited by 39 publications

References 28 publications

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

Altered intestinal function precedes the appearance of bacterial DNA in serum and ascites in patients with cirrhosis: a pilot study

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