Norfloxacin treatment for clinically significant portal hypertension: results of a randomised double‐blind placebo‐controlled crossover trial

Abstract

Norfloxacin is not superior to placebo in reducing HVPG in subjects with clinically significant portal hypertension. Furthermore, norfloxacin does not appear to modulate the l-Arg transporter mechanism in this patient population. Although plasma UII correlates positively with HVPG, UII does not appear to have a direct role in modulating HVPG.

Antibiotic prophylaxis during bleeding for portal hypertension: authors’ reply

“…Although the association of antibiotic prophylaxis and reduced rebleeding rate has been known to be biologically plausible, 5 previous clinical evidence was conflicting. 6,7 Our meta-analysis presents consistent findings, showing the potential benefit of prophylaxis to reduce the number of rebleeding episodes, as well as early rebleeding (within 7 days). However, we recognise that given the limited number of trials (three) more research on this outcome is still needed.…”

“…Hepatology 1998; 27: 1207-12. 7. Tandon P, Garcia-Tsao G. Bacterial The corrected relative risk is 0.42 (95% CI 0.13, 1.15; P-value 0.069), which is not a major change from the one reported in our article.…”

Microbiota and the liver

“…Splanchnic vasodilation mediated by TNF‐α and nitric oxide release leads to worsening portal hypertension, which in turn exacerbates intestinal permeability with further bacterial translocation. Modulation of the gut microbiota via the administration of antibiotics and probiotics have shown promising results in hemodynamic changes in clinical studies of portal hypertension . To further delineate the role of the gut microbiota, Moghadamrad et al showed that in an experimental model of portal hypertension induced by partial portal vein ligation, germ‐free mice exhibited attenuated portal pressures compared with colonized mice .…”

Rifaximin has no effect on hemodynamics in decompensated cirrhosis: A randomized, double‐blind, placebo‐controlled trial

“…Impaired intestinal motility, bacterial overgrowth, and immune dysfunction in the gut are evident in the patient with cirrhosis . In controlled trials, intestinal decontamination with norfloxacin has been shown to be beneficial for inflammation, splanchnic hemodynamics, and clinical outcomes in patients with decompensated cirrhosis …”