Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

Abstract

-Background -The prognosis of patients with chronic liver disease and spontaneous bacterial peritonitis is poor, being of great importance its prevention. Aim -To compare the effectiveness of trimethoprim-sulfamethoxazole versus norfloxacin for prevention of spontaneous bacterial peritonitis in patients with cirrhosis and ascites. Patients and Methods -Fifty seven patients with cirrhosis and ascites were evaluated between March 1999 and March 2001. All of them had a previous episode of spontaneous bacterial peritonitis or had ascitic fluid protein concentration ≤1 g/dL and/or serum bilirubin ≥ 2.5 mg/dL. The patients were randomly assigned to receive either 800/160 mg/day of trimethoprim-sulfamethoxazole 5 days a week or 400 mg of norfloxacin daily. The mean time of observation was 163 days for the norfloxacin group and 182 days for the trimethoprim-sulfamethoxazole group. In the statistical analysis, differences were considered significant at the level of 0.05. Results -According to the inclusion criteria, 32 patients (56%) were treated with norfloxacin and 25 (44%) with trimethoprim-sulfamethoxazole. Spontaneous bacterial peritonitis occurred in three patients receiving norfloxacin (9.4%) and in four patients receiving trimethoprim-sulfamethoxazole (16.0%). Extraperitoneal infections occurred in 10 patients receiving norfloxacin (31.3%) and in 6 patients receiving trimethoprim-sulfamethoxazole (24.0%). Death occurred in seven patients (21.9%) who received norfloxacin and in five (20.0%) who received trimethoprim-sulfamethoxazole. Side effects occurred only in the trimethoprim-sulfamethoxazole group. Conclusion -In spite of the reduced number of patients and time of observation, trimethoprim-sulfamethoxazole and norfloxacin were equally effective in spontaneous bacterial peritonitis prophylaxis, suggesting that trimethoprim-sulfamethoxazole is a valid alternative to norfloxacin.

A randomized controlled study of trimethoprim‐sulfamethoxazole versus norfloxacin for the prevention of infection in cirrhotic patients

“…Nearly a quarter of our cohort died during the study period, with no difference in mortality rate between the N and T‐S groups, similar to other studies using SBP prophylaxis . While we found that the survival rate free of transplantation at 12 months was lower in patients who had an infection than in those who did not, this was not significant (32.5% vs 47.5%, P = 0.18).…”

Spontaneous bacterial peritonitis: recent guidelines and beyond

“…However, four trials also included patients with prior SBP132 139 142 143 and the remaining have recently been summarised in two meta-analyses 136 137. Surprisingly, these came to different conclusions, most likely due to erroneous data extraction 144.…”

Diagnosis and management of bacterial infections in decompensated cirrhosis

“…Several independent studies and meta-analysis have assessed this issue [68][69][70][71] . In a placebo-controlled trial on patients with protein ascitic levels < 15 g/L and advanced liver failure or impaired renal function, norfloxacin (400 mg/d) reduced the 1-year probability of developing SBP and improved the 3-mo survival, although at 1 year the difference in survival was not significant [29] .…”