The Role of Rifaximin in the Primary Prophylaxis of Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis

Hanouneh, Mohamad; Hanouneh, Ibrahim A.; Hashash, Jana G.; Law, Ryan; Esfeh, Jamak Modaresi; López, Rocío; Hazratjee, Nyla; Smith, Thomas H.; Zein, Nizar N.

doi:10.1097/mcg.0b013e3182506dbb

Cited by 89 publications

(67 citation statements)

References 40 publications

(50 reference statements)

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“…Kalambokis et al [31] first described in cohort of 16 cirrhotic patients with no previous episode of SBP that rifaximin can reduce SIBO and BT decreasing the incidence of SBP. These results were corroborated by a retrospective study conducted by Hanouneh et al [32] in 404 cirrhotic patients in which rifaximin was used for hepatic encephalopathy and avoided the occurrence of SBP. However, two others recently published studies could not confirm these results.…”

Section: Pathophysiologysupporting

confidence: 74%

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

Ribeiro¹

2016

Journal of Gastroenterology and Hepatology Research

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Spontaneous bacterial peritonitis is the commonest and a deadly complication of cirrhosis that happens in 10% to 30% of patients admitted to hospital. The main mechanism that is being associated with its occurrence are bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired immune defense. The Gram-negative aerobic bacteria are the major pathogens responsible for SBP episodes although Gram-positive bacteria are being considered emergent agents. The ready diagnosis of SBP is a key factor for the decrease in mortality rates observed in recent years. The medical diagnosis is neither sensitive nor specific and the search for new useful and available tools to make it quicker is an important endpoint of current studies. The use of empirical antibiotics, mainly cefotaxime, improves significantly the shortterm prognosis of patients with SBP. The recurrence rate is high and antibiotic prophylaxis has been recommended in high-risk scenarios. Unfortunately, the long-term prognosis remains poor.

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Section: Pathophysiologysupporting

confidence: 74%

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

Ribeiro¹

2016

Journal of Gastroenterology and Hepatology Research

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“…A cohort study by Hanouneh et al found a transplant-free survival benefit with the use of rifaximin in cirrhotic patients with ascites and no prior history of SBP than those who didn't receive antibiotic prophylaxis. 41 Another prospective case-control study by Danulescu et al suggested that rifaximin can significantly decrease the polymorphonuclear leukocytic count in ascitic fluid of cirrhotic patients with refractory ascites compared to placebo, with a net improvement of the general condition. 42 Vlachogiannakos et al also showed that patients who received rifaximin had a significantly lower risk of developing variceal bleeding, hepatic encephalopathy (HE), SBP and hepatorenal syndrome than matched control subjects who did not receive antibiotic prophylaxis, in addition to significantly higher five-year cumulative probability of survival.…”

Section: Discussionmentioning

confidence: 98%

Rifaximin: A reasonable alternative for norfloxacin in the prevention of spontaneous bacterial peritonitis in patients with HCV-related liver cirrhosis

Madkour

2016

Alexandria Journal of Medicine

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Background: Norfloxacin is the most commonly used agent for the prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Rifaximin, another broad spectrum antibiotic, is used for the treatment of traveler's diarrhea and hepatic encephalopathy. Objective: We aimed to test the efficacy of rifaximin versus norfloxacin for prevention of SBP in patients with hepatitis C virus (HCV)-related liver cirrhosis. Patients and methods: 86 patients with HCV-related liver cirrhosis and ascites were enrolled and divided into two groups of matching age, sex and Child-Pugh class. Group I was given norfloxacin 400 mg/day as single dose, and group II rifaximin 1200 mg/day in three divided doses. They were followed for up to one year. Study endpoints were SBP, hepatocellular carcinoma, compliance failure, death, or liver transplantation. Results: More than 70% of patients received the antimicrobial as primary prophylaxis and the rest were given secondary prophylaxis against SBP. The mean follow-up period was 10.16 ± 2.64 months for norfloxacin and 10.26 ± 2.32 months for rifaximin (p = 0.863). Although statistically insignificant (p = 0.265), patients on rifaximin developed fewer episodes of SBP than those on norfloxacin (4.7% vs. 14%). Also, the infection-free duration before SBP was longer (p = 0.129) with rifaximin than norfloxacin (9.5 vs. 5.0 months). Rifaximin significantly reduced the rate of new compared to past episodes of SBP by 20.9% (p = 0.007) vs. 13.9% for norfloxacin (p = 0.112). Overall survival was equal in both groups. Patients adhered to therapy regimen of norfloxacin for significantly longer time than rifaximin (p = 0.010). Conclusion: Rifaximin is -at least -as good as norfloxacin. It seems to be an appropriate alternative for long-term primary and secondary prophylaxis of SBP in cirrhotic patients with ascites. Modification of dose regimen should be considered to improve patient's compliance to rifaximin.

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“…En revanche, l'utilisation de la rifaximine dans l'EH n'avait pas entrainé l'émergence de bactéries résistantes [11]. Les principales caractéristiques de la rifaximine qui pourraient expliquer ce résultat sont essentiellement liées au fait qu'elle atteint des concentrations fécales élevées en étant quasiment pas absorbée [12,13]. Du fait de la faible absorption de la rifaximine (<0,4% de passage systémique), les concentrations en antibiotique restent largement supérieures aux concentrations minimales inhibitrices des bactéries [12].…”

Section: Discussionunclassified

“…De plus, la rifaximine réduit l'expression de facteurs de virulence bactérienne et compromet le transfert de plasmides, mécanismes qui interviennent dans l'émergence de résistan-ces et n'entraine qu'une altération minime de la flore bacté-rienne intestinale. Ces caractéristiques ne sont pas propices au développement de résistances [13]. Les bactéries cocci gram positif aérobies seraient les plus susceptibles de déve-lopper ce type de résistance, selon des données in vitro.…”

Section: Discussionunclassified

La rifaximine : une nouvelle alternative dans la prévention des infections bactériennes chez le cirrhotique ?

Ennaifer

Elleuch

Cheikh

et al. 2015

J Afr Hepato Gastroenterol

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The Role of Rifaximin in the Primary Prophylaxis of Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis

Abstract: Intestinal decontamination with rifaximin may prevent SBP in cirrhotic patients with ascites. Prospective randomized controlled trials are needed to confirm this finding.

Cited by 89 publications

References 40 publications

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

Rifaximin: A reasonable alternative for norfloxacin in the prevention of spontaneous bacterial peritonitis in patients with HCV-related liver cirrhosis

La rifaximine : une nouvelle alternative dans la prévention des infections bactériennes chez le cirrhotique ?

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