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 25 May 2018

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Ciprofloxacin for prophylaxis of spontaneous bacterial peritonitis

The most recent issue of the Journal of Hepatology assesses ciprofloxacin as primary prophylaxis of spontaneous bacterial peritonitis.

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Low protein concentration in ascitic fluid has been identified as a risk factor for spontaneous bacterial peritonitis.

Until now, primary prophylaxis has not been recommended in these patients.

Dr Rubén Terg and colleagues from Argentina investigated the efficacy of long-term administration of ciprofloxacin to prevent spontaneous bacterial peritonitis.

The probability of survival at 12 months was 86% with ciprofloxacin
Journal of Hepatology

The team prospectively randomized 100 hundred cirrhotic patients with less than 1.5g/dl of total protein in ascitic fluid.

The team reported that 50 patients received ciprofloxacin 500mg/day, and 50 received placebo for 12 months.

The researchers found that baseline data were similar in both groups.

In the ciprofloxacin group, spontaneous bacterial peritonitis occurred almost 4 times less frequently than in the placebo group but it was not statistically significant.

The team found the probability of survival at 12 months was significantly higher in patients receiving ciprofloxacin, at 86% versus 66% in the placebo group.

Spontaneous bacterial peritonitis and sepsis were the most frequent causes of death in the placebo group.

However, the researchers noted that gastrointestinal bleeding was responsible for the most deaths in the ciprofloxacin group.

The probability of remaining free of bacterial infections was higher in patients receiving ciprofloxacin, at 80% versus 55% in the placebo group.

Dr Terg's team concluded, "Patients with cirrhosis and low protein concentration in ascitic fluid are candidates to receive long-term prophylaxis to reduce the risk of infections and improve survival."

J of Hepatology 2008: 48(5): 744-79
07 April 2008

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