Prophylactic antibiotics have been recommended in patients with a previous history of spontaneous bacterial peritonitis.
Recently, there has been interest in the use of rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome.
Dr Faisala Kamal and colleagues conducted a meta-analysis to evaluate this association of rifaximin.
The team searched several databases from inception through 2017, to identify comparative studies evaluating the effect of rifaximin on the occurrence of SBP and hepatorenal syndrome.
The researchers performed predetermined subgroup analyses based on the type of control group, design of the study, and type of prophylaxis.
|In the quinolone group, pooled odds ratio was 0.42|
|European Journal of Gastroenterology & Hepatology|
The research team included 13 studies with 1703 patients in the meta-analysis of spontaneous bacterial peritonitis prevention.
The team found that the pooled odds ratio was 0.40.
On sensitivity analysis, the research team observed that the adjusted odds ratio was 0.29.
The research team found that in the quinolone group, pooled odds ratio was 0.42, and in the no antibiotic group, pooled odds ratio was 0.40.
However, with sensitivity analysis, benefit of rifaximin was demonstrable; pooled odds ratio were 0.32, and 0.28 for the comparison with quinolones and no antibiotics, respectively.
Pooled odds ratio based on randomized controlled trials was 0.41.
For the prevention of hepatorenal syndrome, the pooled odds ratio was 0.25.
Dr Kamal's team concludes, "Rifaximin has a protective effect against the development of spontaneous bacterial peritonitis in cirrhosis."
"However, the quality of the evidence as per the GRADE framework was very low."
"Rifaximin appeared effective for the prevention of hepatorenal syndrome."