Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Hepatol Int. 2020 May;14(3):399-413. doi: 10.1007/s12072-020-10025-1. Epub 2020 Apr 7.
Various antibiotic regimens are used for primary and secondary prevention of spontaneous bacterial peritonitis (SBP). A systematic review and network meta-analysis to compare various antibiotics regimens for primary and secondary prevention of SBP were done.
We did a comprehensive literature search using various databases (i.e. MEDLINE via Ovid and PubMed, Embase, Cochrane Central Register of Controlled Trials and others) from inception to 26th October 2019 using various keywords. Only randomised studies which evaluated the role of antibiotics in adult cirrhotic patients with ascites for primary or secondary prophylaxis of SBP were included. The primary outcome was occurrence/recurrence of SBP episode and other outcomes assessed were extra-peritoneal infections and reduction in mortality. We did random-effects network meta-analysis using a Bayesian approach, and calculated odds ratios (ORs) and 95% credible intervals (CrI); agents were ranked using rank probabilities.
We found total 1701 records in our systematic database search and out of these 17 randomised trials were found eligible for network meta-analysis. For primary prevention of SBP, the odds ratio (95% CrI) for norfloxacin daily was 0.061 (0.0060, 0.33) and for rifaximin daily was 0.037 (0.00085, 0.87) and norfloxacin and rifaximin alternate month was 0.027 (0.00061, 0.61) when compared to placebo or no comparator. For the secondary prevention of SBP, rifaximin daily had odds of 0.022 (0.00011, 0.73).
Rifaximin is useful for both primary and secondary prevention of SBP whereas norfloxacin daily and alternate norfloxacin and rifaximin are useful for primary prophylaxis.
各种抗生素方案被用于自发性细菌性腹膜炎（SBP）的一级和二级预防。我们进行了一项系统评价和网络荟萃分析，以比较各种抗生素方案用于 SBP 的一级和二级预防。
我们使用各种数据库（即通过 Ovid 和 PubMed 的 MEDLINE、Embase、Cochrane 对照试验中心注册等）从开始到 2019 年 10 月 26 日进行了全面的文献检索，使用了各种关键词。只有评估抗生素在肝硬化腹水成人患者中用于 SBP 一级或二级预防作用的随机研究才被纳入。主要结局是 SBP 发作的发生/复发，其他评估的结局是腹膜外感染和死亡率降低。我们使用贝叶斯方法进行了随机效应网络荟萃分析，并计算了比值比（OR）和 95%可信区间（CrI）；使用排名概率对药物进行排名。
我们在系统数据库搜索中发现了 1701 条记录，其中 17 项随机试验符合网络荟萃分析的条件。对于 SBP 的一级预防，与安慰剂或无对照相比，每日诺氟沙星的 OR（95%CrI）为 0.061（0.0060，0.33），每日利福昔明为 0.037（0.00085，0.87），每月交替使用诺氟沙星和利福昔明为 0.027（0.00061，0.61）。对于 SBP 的二级预防，每日利福昔明的 OR 为 0.022（0.00011，0.73）。
利福昔明对 SBP 的一级和二级预防均有效，而每日诺氟沙星和交替使用诺氟沙星和利福昔明对一级预防有效。
