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Rifaximin plus norfloxacin versus norfloxacin alone in primary prophylaxis of spontaneous bacterial peritonitis in patients with variceal bleeding

The Egyptian Journal of Internal Medicine volume 31, pages 281–287 (2019)Cite this article

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Abstract

Background

Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid in the absence of other intra-abdominal sources. The risk is high in those with concomitant gastrointestinal bleeding, low ascitic fluid protein, or a previous attack of SBP. Norfloxacin is used widely in the primary prophylaxis of SBP but resistance usually develops where rifaximin was introduced.

Patients and methods

A total of 80 patients with advanced liver cirrhosis attending the Hemostasis Unit, Emergency Hospital, Mansoura University, with upper gastrointestinal bleeding were subjected to full history, clinical examination, laboratory assessment, and ascitic fluid analysis. The patients were divided into two groups: the first group received rifaximin plus norfloxacin and the second group received norfloxacin only and the two groups were followed up for 1 year.

Results

The study enrolled 80 patients, 51 men and 29 women with a mean age of 58.83±5.02 years for group 1 and 58.35±4.95 years for group 2. There were no statistically significant difference between the two groups as regards the clinical or laboratory characteristics except for the presence of focal lesions that was significantly present in group 2. A significant increase in the incidence of SBP in group 2 was present with P=0.014. The median time of developing SBP was significantly shorter in the second group.

Conclusion

The addition of rifaximin to norfloxacin decreased the incidence rates of SBP in patients with variceal bleeding with significant improvement in patient survival.

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Authors and Affiliations

  1. Department of Internal Medicine, Hepatology and Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed A. Ghafar MD & Salah Rozaik

  2. Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed Akef

Authors
  1. Ahmed A. Ghafar MD
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  2. Salah Rozaik
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  3. Ahmed Akef
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Correspondence to Ahmed A. Ghafar MD.

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Ghafar, A.A., Rozaik, S. & Akef, A. Rifaximin plus norfloxacin versus norfloxacin alone in primary prophylaxis of spontaneous bacterial peritonitis in patients with variceal bleeding. Egypt J Intern Med 31, 281–287 (2019). https://doi.org/10.4103/ejim.ejim_6_19

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