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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. Methods: 100 patients with HCV-related liver cirrhosis and ascites were included in study and divided into two groups of matching age, sex and Child-Pugh class. Group I patients were given norfloxacin 400 mg/day and group II patients were given total dose of rifaximin 1200 mg/day in three divided doses. The follow up time was one year. Results: Patients on rifaximin developed fewer episodes of SBP than those on norfloxacin (8% vs 16% respectively) although it was statistically insignificant (p=0.265). Also, the duration before developing a new attack of SBP was longer in patients treated with rifaximin as compared to those taking norfloxacin (9.0 vs. 5.5 months, respectively). Additionally, rifaximin significantly reduced the rate of new compared to past episodes of SBP by 24% (p while the rate reduction with norfloxacin was only by 18% and not statistically significant (p= 0.45). Overall survival was equal in both groups. 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.

1.Introduction Cirrhosis is the end stage of chronic liver disease. Ascites and esophageal varices (EVs) are the most common complications of portal hypertension (PHT), with an incidence of approximately 50% [1]. Since effective preventive modalities have been established for variceal haemorrhage, early detection of EVs is critical for primary prevention of bleeding. Upper gastrointestinal endoscopy (UGE) remains the gold standard for screening [2,3]. However, many studies have been conducted to predict PHT and EV with a diverse rate of accuracy. All patients with cirrhosis should undergo UGE screening to identify those at high risk of bleeding and who may benet from primary prophylaxis, since EVs are an independent predictive factor and an early complication of cirrhosis. The test should also be repeated during the follow-up of patients with cirrhosis without EVs, who are at risk of bleeding, with or without decompensation [1]. Though UGiscopy is the gold standard to screen patients for variceal development; but has has many drawbacks such as being relatively expensive, invasive, and restrictive [4]. Such a screening test should be simple, rapid, reproducible, and inexpensive [5–7]. The serum ascites albumin gradient (SAAG) is a minimally invasive method that is precise and has been described in the classication of ascitic uid(AF) based on the presence or absence of PHT [8]. Many Studies have been performed to identify non-invasive parameters for the prediction of EVs in patients newly diagnosed with cirrhosis [5]. SAAG can be considered an indirect parameter for the detection of EVs and is useful in regions where there are limitations to perform UGE. The aim of our study was to evaluate the role of SAAG in the prediction of EVs in cirrhotic patients with ascites.