Oliver Ashley, Wong Mark, Sanchez Chelsea
From the South Texas Veterans Health Care System, and the Department of Pharmacotherapy, University of Texas, Austin.
South Med J. 2018 Nov;111(11):660-665. doi: 10.14423/SMJ.0000000000000887.
Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those deemed to be at high risk often are prescribed antibiotics to reduce the incidence of SBP. Fluoroquinolones and sulfamethoxazole-trimethoprim are commonly used antibiotics for long-term prevention for these specified populations; however, these antibiotics are associated with several adverse effects and interactions that may be harmful to patients. In addition, resistance development may decrease the efficacy of SBP treatment and prophylaxis. Given these limitations, rifaximin, a nonabsorbable, broad-spectrum antibiotic that is used for hepatic encephalopathy, may serve as a prophylactic alternative to conventional therapy. This review discusses guideline-recommended therapy and the evidence for using rifaximin for SBP prophylaxis.
肝硬化影响着全球数百万人，与发病率和死亡率的增加相关。自发性细菌性腹膜炎（SBP）是肝硬化肝病的常见并发症，占肝硬化患者感染的30%。有SBP病史的患者和那些被认为高危的患者通常会使用抗生素来降低SBP的发病率。氟喹诺酮类和磺胺甲恶唑-甲氧苄啶是常用于这些特定人群长期预防的抗生素；然而，这些抗生素与几种可能对患者有害的不良反应和相互作用有关。此外，耐药性的产生可能会降低SBP治疗和预防的效果。鉴于这些局限性，利福昔明，一种用于肝性脑病的不可吸收的广谱抗生素，可能作为传统疗法的预防性替代药物。本综述讨论了指南推荐的治疗方法以及使用利福昔明预防SBP的证据。
