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 24 May 2018

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Rifaximin for the prophylaxis of spontaneous bacterial peritonitis

The latest issue of the Alimentary Pharmacology & Therapeutics evaluated the efficacy of rifaximin in the primary and secondary prevention of spontaneous bacterial peritonitis.

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The primary and secondary prevention of spontaneous bacterial peritonitis is recommended in high-risk patients with cirrhosis.

Several studies evaluating the efficacy of rifaximin for spontaneous bacterial peritonitis prophylaxis have yielded conflicting results.

Rifaximin has the potential advantage of preventing bacterial overgrowth and translocation without the systemic side effects of broad-spectrum antibiotics.

Dr Goel and colleagues evaluated the efficacy of rifaximin in the primary and secondary prevention of spontaneous bacterial peritonitis.

The researchers performed a literature search using 5 databases to identify studies on the association between rifaximin and spontaneous bacterial peritonitis.

The odds ratio for spontaneous bacterial peritonitis was 0.34 in patients receiving rifaximin
Alimentary Pharmacology & Therapeutics

The research team performed 2 meta-analyses, of which one compared rifaximin to systemic antibiotics, and the other compared rifaximin to no antibiotics.

The team identified 5 studies with 555 patients that compared rifaximin with systemic antibiotics.

The pooled odds ratio for spontaneous bacterial peritonitis was 0.45 in patients receiving rifaximin and strengthened on sensitivity analysis.

In the analysis comparing rifaximin with no antibiotics, there were 5 studies with 784 patients.

The researchers noted that the odds ratio for spontaneous bacterial peritonitis was 0.34 in patients receiving rifaximin.

In subgroup analysis, rifaximin reduced the risk of spontaneous bacterial peritonitis by 47% compared to no antibiotics for primary prophylaxis, and by 74% compared to systemic antibiotics for secondary prophylaxis.

Dr Goel's team concludes, "Rifaximin may be effective in preventing spontaneous bacterial peritonitis in patients with cirrhosis and ascites compared to systemically absorbed antibiotics and compared to placebo."

Aliment Pharmacol Ther 2017: 46(11-12): 1029–1036
08 November 2017

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