Oral norfloxacin is the standard of therapy in the prophylaxis of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage.
However, during the last years, the epidemiology of bacterial infections in cirrhosis has changed.
There is a higher incidence of infections caused by quinolone-resistant bacteria.
Dr Javier Fernandez and colleagues from Spain compared oral norfloxacin vs intravenous ceftriaxone in the prophylaxis of bacterial infection.
The researchers evaluated 111 patients with advanced cirrhosis with gastrointestinal bleeding.
The patients were randomly treated with oral norfloxacin, 400 mg twice daily, or intravenous ceftriaxone 1 g/day for 7 days.
|7 gram-negative bacilli were isolated in the norfloxacin group
The end point of the trial was the prevention of bacterial infections within 10 days after inclusion.
The researcher reported that clinical data were comparable between groups.
The probability of developing proved or possible infections, proved infections, was higher in patients receiving norfloxacin.
The team noted that spontaneous bacteremia or spontaneous bacterial peritonitis was significantly higher in patients receiving norfloxacin.
The type of antibiotic used, transfusion requirements at inclusion, and failure to control bleeding were independent predictors of infection.
The researchers isolated 7 gram-negative bacilli in the norfloxacin group, and observed that 6 were quinolone resistant.
Nonenterococcal streptococci were only isolated in the norfloxacin group.
The team did not observe any difference in hospital mortality between groups.
Dr Fernández's team comments, “Intravenous ceftriaxone is more effective than oral norfloxacin in the prophylaxis of bacterial infections in patients with advanced cirrhosis and hemorrhage.”