Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites

Grangé, Jean‐Didier; Roulot, Dominique; Pelletier, Gilles; Pariente, Emile-Alexandre; Denis, Jacques; Ink, Olivier; Blanc, P; Richardet, Jean Philippe; Vinel, Jean Pierre; Delisle, F.; Fischer, D; Flahault, Antoine

doi:10.1097/00042737-199810000-00021

Cited by 13 publications

(30 citation statements)

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“…These results are higher than those reported in the literature (3,17,32,41,42) . A probable explanation for the higher incidence of infections obtained in our series may be the severity of the liver disease in our patients as compared to those of other studies.…”

Section: Discussioncontrasting

confidence: 79%

“…The most frequent infection observed in this study was SBP, and the most common extraperitoneal infection was urinary infection as seen in other series of SBP prophylaxis (13,17,32,42) . Even though, it should be noticed that in the NO group, 4 cases of potentially more severe infection occurred -sepsis, with two deaths, comparing to the absence of cases in the SMZ/TMP group.…”

Section: Discussionsupporting

confidence: 74%

“…GINÉS et al (16) included 80 patients and the series of GRANGÉ et al (17) was larger, with 107 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of SBP during prophylaxis with NO, ranged from 0% to 35% in several series (13,16,17,32,42) . For the SMZ/TMP group, the only result available in the literature so far is the one of SINGH et al (41) : 3%.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, low-protein ascitic fluid (below 1.5 or 1 g/dL) was recognized as a predisposing factor to the development of SBP (24,37) . Despite the favorable results in studies evaluating this form of prophylaxis (17,32,42) , the lack of an unequivocal benefit in survival, the inconsistency of the groups studied, and the emergence of resistant bacteria have rendered the indication of primary prophylaxis of SBP disputable. The presence of hyperbilirubinemia, indicating liver dysfunction, could be another element suggesting the importance of this kind of prophylaxis (2) .…”

Section: Introductionmentioning

confidence: 99%

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

Álvarez

Mattos

Corrêa

et al. 2005

Arq. Gastroenterol.

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-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.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionsupporting

confidence: 74%

“…GINÉS et al (16) included 80 patients and the series of GRANGÉ et al (17) was larger, with 107 patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Álvarez

Mattos

Corrêa

et al. 2005

Arq. Gastroenterol.

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Bacterial translocation (BT) in cirrhosis†

Wiest¹,

2005

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Infections Caused By Escherichia Coli Resistant to Norfloxacin in Hospitalized Cirrhotic Patients

Ortiz¹,

Vila²,

Soriano³

et al. 1999

Hepatology

112

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Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n ‫؍‬ 67), infections caused by E. coli sensitive to norfloxacin, and group II (n ‫؍‬ 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P F .0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P ‫؍‬ .01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

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Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites

Cited by 13 publications

References 0 publications

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

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

Bacterial translocation (BT) in cirrhosis†

Infections Caused By Escherichia Coli Resistant to Norfloxacin in Hospitalized Cirrhotic Patients

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