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Rifaximin may prevent recurrence of spontaneous bacterial peritonitis
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BARCELONA — Rifaximin was associated with significantly lower disease recurrence and mortality than norfloxacin in a cohort of patients with spontaneous bacterial peritonitis, according to findings presented at the International Liver Congress.
Sherief Abd-Elsalam, MD, of the Department of Tropical Medicine and the Tanta University Faculty of Medicine in Tanta, Egypt, said that spontaneous bacterial peritonitis has a high recurrence rate and leads to increases in mortality. “The most severe complication of spontaneous bacterial peritonitis is the hepatorenal syndrome, which occurs in up to 30% of patients and carries a high mortality rate,” he said.
Norfloxacin is commonly used as secondary prophylaxis of the disease. However, quinolone-resistant and gram-positive spontaneous bacterial peritonitis have increased. He suggested that rifaximin is a non-absorbable broad spectrum antibiotic that may not lead to resistance and prevent these complications as a form of secondary prophylaxis.
The aim of the current study was to compare the two drugs for secondary prevention of the disease in a cohort of 262 patients with cirrhosis and ascites. The final analysis included 103 patients treated with 1,200 mg rifaximin and 92 patients treated with 400 mg norfloxacin daily for 6 months.
Recurrence occurred significantly less frequently in the rifaximin group, 3.88% vs. 14.13% (P = .04). Mortality also was significantly lower in the rifaximin group, 13.74% vs. 24.43% (P = .044).
There were no significant differences between the groups in terms of causes of death (P = .377). However, more patients who were treated with norfloxacin died from encephalopathy.
Other results indicated that white blood cell counts in ascitic fluid at 2 months were 148.5 cells/mm3 (40-520) in the rifaximin group and 154 cells/mm3 (89-440) in the norfloxacin group. At 6 months, the rates were 94 cells/mm3 (37-650) for rifaximin and 100 cells/mm3 (40-600) for norfloxacin.
The polymorphonuclear cell counts in ascitic fluid at 2 months were 73 cells/mm3 for rifaximin and 73.5 (0-396) for norfloxacin. At 6 months, those rates were 46 cells/mm3 (6-450) for rifaximin and 55 (4-380) in the norfloxacin group (P = .7).
Adverse event rates were significantly decreased in patients treated with rifaximin compared with those treated with norfloxacin (P = .033).
“Intestinal decontamination with rifaximin may be an attractive approach to prevent the recurrence of SBP,” Abd-Elsalam said. “Rifaximin is a nearly ideal antibiotic to prevent spontaneous bacterial peritonitis in the absence of systemic side effects.”
Reference:
Abd Elsalam S, et al. Abstract LB04. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.
Disclosures: The researchers report no relevant financial disclosures.