Primary prophylaxis with ciprofloxacin in cirrhotic patients with ascites: a randomized, double blind study

Téllez-Ávila, Félix Ignacio; Sifuentes–Osornio, José; Barbero-Becerra, Varenka J.; Franco-Guzmán, Ada M.; Ruíz-Cordero, Roberto; Alfaro-Lara, Roberto; Hernández-Ramírez, Ángeles; Vargas-Voráckóva, Florencia

doi:10.1016/s1665-2681(19)30906-8

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…55 Six studies were included in their analyses. [56][57][58][59][60][61] The European Association for the Study of Liver (EASL) recommend primary prophylaxis with norfloxacin (400 mg/day) in patients with Child-Pugh score ≥9 and serum bilirubin ≥3 mg/dL, with either impaired renal function or hyponatraemia and ascitic fluid protein lower than 15 g/L. 47 The American Association for the Study of Liver Diseases (AASLD) also suggest that antibiotics for primary prophylaxis of SBP should be considered for people at high risk of developing this complication, which was defined as an ascitic fluid protein <1.5 g/dL together with impaired renal function or liver failure.…”

Section: Primary Prophylaxismentioning

confidence: 99%

Guidelines on the management of ascites in cirrhosis

Aithal

Palaniyappan

China

et al. 2020

Gut

335

275

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The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE)’ system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years’ time.

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Section: Primary Prophylaxismentioning

confidence: 99%

Guidelines on the management of ascites in cirrhosis

Aithal

Palaniyappan

China

et al. 2020

Gut

335

275

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“…Tellez-Avila et al evaluated the effectiveness of ciprofloxacin for the primary prevention of bacterial infections in patients with liver cirrhosis and ascites. 14 95 individuals were randomly assigned to the ciprofloxacin (N=49; 51.6%) or placebo (N=46; 48.4%) group. In the ciprofloxacin group, sixteen (32.6%) patients acquired bacterial infections, whereas thirteen (28.2%) patients in the placebo group developed bacterial infections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intravenous ceftriaxone and ciprofloxacin in prevention of infection in cirrhosis patients with variceal bleeding

et al. 2023

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Background: Patients with variceal gastrointestinal bleeding are very susceptible to bacterial infections. This study was designed to examine the effectiveness of ciprofloxacin and ceftriaxone in controlling in-hospital morbidity, mortality, and infection in variceal bleeding patients. Methods: From August 2010 to August 2012, an interventional randomized controlled clinical trial was conducted in the Department of Gastroenterology, East Medical Ward, Mayo Hospital, Lahore. Adult patients who were diagnosed to have gastroesophageal variceal bleeding after endoscopic examination were included. These patients were randomly distributed to 2 groups. Group ceftriaxone: receiving injection Ceftriaxone 1000 mg intravenously 12 hourly for 7 days, Group ciprofloxacin: receiving injection ciprofloxacin 200 mg intravenously 12 hourly for 7 days. Results: Most common viral etiology was Hepatitis C in both the study groups. It was observed that in the ceftriaxone group, 4.8% had rebleeding, while in the ciprofloxacin group 5.6% had rebleeding (p=0.77), one case each had porto-systemic encephalopathy (p=0.99), 0.8% in ceftriaxone group and 3.2% in ciprofloxacin group had spontaneous bacterial peritonitis (p=0.39) and 4.8% in ceftriaxone group and 8% in ciprofloxacin group had systemic inflammatory response syndrome (p=0.31). No patients died during one week follow up. Conclusions: From our study, it was concluded that ciprofloxacin and ceftriaxone had same efficacy when used intravenously for prevention of bacterial infection and improvement in mortality and morbidity in patient of variceal bleeding. Future multicentric studies are required with a longer patient follow to support our findings.

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“…Also, the consideration for empiric antibiotics for bacteremia and possible fungal infections in the cirrhotic. Interestingly, the connection between spontaneous bacterial peritonitis (SBP) and the prophylactic use of ciprofloxacin is well established, although the necessity to empirically cover for fungus in the cirrhotic septic patient is not 11 . Of note, other immunosuppressive conditions such as HIV are treated with prophylactic medications to prevent serious infections, including fungal infections.…”

Section: Discussionmentioning

confidence: 99%