Department of Gastroenterology, West China Hospital of Sichuan University, NO.37 GuoXue Street, Chengdu, 610041, Sichuan, China.
Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
BMC Infect Dis. 2023 Aug 28;23(1):557. doi: 10.1186/s12879-023-08557-6.
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with advanced cirrhosis. Prophylactic Norfloxacin used to be considered effective in SBP prevention, but in recent years its efficacy has been partially compromised by increasing quinolone-resistant bacteria. However, whether the effects of alternative prophylactic regimens are superior to norfloxacin remains controversial. The goal of this study is to compare the effects of norfloxacin with other antibiotics in SBP prophylaxis for cirrhotic patients.
We systematically searched Pubmed, Embase, and Cochrane Library Databases. Two reviewers independently identified relevant random control trials (RCTs) comparing the role of norfloxacin and other antibiotics in SBP prevention.
Eight studies comprising 1043 cirrhotic patients were included in this study. Norfloxacin and alternative antibiotics displayed comparable effects in SBP prophylaxis, survival benefit, overall infection prevention, and safety. Subgroup analyses revealed that rifaximin prophylaxis could reduce the recurrence of SBP with fewer adverse events but failed to improve overall survival compared with norfloxacin.
Other antibiotics are a reasonable alternative to norfloxacin in the prophylaxis of SBP. Rifaximin prophylaxis could be an alternative choose of antibiotic for SBP prevention because of its better protective effect and safety.
自发性细菌性腹膜炎（SBP）是肝硬化患者的一种危及生命的并发症。预防性使用诺氟沙星曾经被认为对 SBP 的预防有效，但近年来，由于耐喹诺酮类细菌的增加，其疗效已部分受到影响。然而，替代预防方案的效果是否优于诺氟沙星仍存在争议。本研究旨在比较诺氟沙星与其他抗生素在肝硬化患者 SBP 预防中的作用。
我们系统地检索了 Pubmed、Embase 和 Cochrane Library 数据库。两位审查员独立识别了比较诺氟沙星和其他抗生素在 SBP 预防作用的相关随机对照试验（RCT）。
本研究共纳入了 8 项研究，包括 1043 例肝硬化患者。诺氟沙星和其他抗生素在 SBP 预防、生存获益、总体感染预防和安全性方面的效果相当。亚组分析显示，利福昔明预防可降低 SBP 的复发，且不良反应较少，但与诺氟沙星相比，并未改善总体生存率。
其他抗生素是预防 SBP 的一种合理替代诺氟沙星的方法。利福昔明预防可能是 SBP 预防的抗生素替代选择，因为它具有更好的保护作用和安全性。
