Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage

Soriano, Germán; Guarner, Carlos; Tomás, Albert; Villanueva, Càndid; Torras, Xavier; Gonzalez, D.; Sainz, Sergio; Anguera, A; Segura, Xavier Cussó i; Balanzó, Joaquím; Vilardell, F

doi:10.1016/0016-5085(92)91514-5

Cited by 291 publications

(196 citation statements)

References 34 publications

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“…[19][20][21][22][23][24][25][26][27][28] Initial studies showed that infections in cirrhotic patients receiving prophylactic norfloxacin were almost exclusively caused by gram-positive cocci, mainly streptococci, and gram-negative bacilli were rarely isolated, [20][21][22] as a result of the antimicrobial spectrum of norfloxacin. 49 However, it has recently been suggested that prophylaxis with norfloxacin would favor the development of infections caused by gram-negative bacilli resistant to norfloxacin in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] This has changed in the last years, as a recent study observed the presence of E. coli resistant to norfloxacin in 40% of stool cultures of cirrhotic patients previously submitted to prophylaxis with norfloxacin, 51 and the emergence of infections caused by E. coli resistant to quinolones is increasingly reported in these patients. 23,36 This is probably a result of the current widespread use of quinolones in the general population, 30,31 as well as in cirrhotic patients 23 in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…48 We determined the number of patients submitted to prophylaxis with oral norfloxacin (400 mg/day or 400 mg twice daily) previously to the diagnosis of the infection for belonging to any of the following groups at high-risk of infection: gastrointestinal hemorrhage, previous SBP, low ascitic fluid total protein levels or high serum bilirubin. [20][21][22][23][24] The relationship between the development of infections caused by norfloxacin-resistant E. coli and prophylaxis with norfloxacin was evaluated considering the presence of previous or present prophylaxis and the cumulative duration of prophylaxis. ''Previous prophylaxis'' was considered when patients had been previously submitted to prophylaxis with norfloxacin at any time.…”

Section: Methodsmentioning

confidence: 99%

“…18 Several controlled clinical trials have shown the efficacy of antibiotic prophylaxis, mainly selective intestinal decontamination with oral norfloxacin, in the prevention of SBP and other bacterial infections in cirrhotic patients at high risk of infection. [19][20][21][22][23][24][25][26][27][28] These studies showed changes in the bacteria responsible for the infections, because cirrhotic patients submitted to prophylaxis with norfloxacin were infected almost exclusively by gram-positive cocci and gram-negative bacilli were rarely observed because of the apparent absence of resistance to quinolones by these bacteria. [19][20][21][22][23][24]29 However, recent studies have shown an increasing incidence in the resistance of gram-negative bacilli to quinolones in the general population, [30][31][32] as well as in neutropenic [33][34] and cirrhotic 23,35,36 patients submitted to prophylaxis with these antibiotics.…”

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confidence: 98%

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Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

Ortiz¹,

Vila²,

Soriano³

et al. 1999

Hepatology

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112

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Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n ‫؍‬ 67), infections caused by E. coli sensitive to norfloxacin, and group II (n ‫؍‬ 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P F .0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P ‫؍‬ .01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 98%

See 2 more Smart Citations

Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

Ortiz¹,

Vila²,

Soriano³

et al. 1999

Hepatology

Self Cite

112

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“…5 Selective intestinal decontamination is also effective in preventing bacterial infections in bleeding cirrhotics. 6 The effectiveness of norfloxacin might decrease with time because of the selection of resistant bacterial strains that could subsequently colonize the gut and become a potential source of infection, especially in those patients on long-term prophylactic treatment. 7 Alternative antibiotics to norfloxacin or, preferably, nonantibiotic drugs should therefore be evaluated in experimental models of cirrhosis and thereafter in clinical trials.…”

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confidence: 99%

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

et al. 2000

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Deranged intestinal motility, which occurs in cirrhosis, may facilitate the development of intestinal bacterial overgrowth (IBO), which can lead to bacterial translocation (BT). To assess the effect of cisapride on IBO and BT in cirrhosis, cirrhotic rats received cisapride or a placebo for 7 days, and measurements of jejunal bacterial content and BT studies were performed. In addition, jejunal fluid from 46 cirrhotic patients was obtained for quantitative bacterial culture. Those patients in whom gram-negative IBO was detected were randomized to receive or not to receive cisapride (20 mg twice per day) for 1 week. Cisapride significantly reduced IBO in cirrhotic rats. In addition, no BT was documented in treated animals, whereas it occurred in 40% in nontreated cirrhotic rats. Total IBO was documented in 23 of 46 cirrhotic patients, which was caused by gram-negative organisms in 10 cases. Orocecal transit time (OCT) significantly decreased after cisapride therapy, and was associated with the abolishment of bacterial overgrowth caused by gram-negative organisms in 4 out of 5 treated patients, whereas it persisted in nontreated cases. Cisapride administration to cirrhotic rats resulted in a reduction of the IBO, which is associated with a marked decrease in BT. On the other hand, cisapride facilitates the abolition of IBO caused by gram-negative organisms in cirrhotic patients. (HEPATOLOGY 2000;31:858-863.)

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Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding

Soares‐Weiser

Brezis

Tur-Kaspa

et al. 2002

Cochrane Database of Systematic Reviews

138

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Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage

Cited by 291 publications

References 34 publications

Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

Infections caused byescherichia coliresistant to norfloxacin in hospitalized cirrhotic patients

Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis

Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding

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