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Norfloxacin, ciprofloxacin, trimethoprim–sulfamethoxazole, and rifaximin for the prevention of spontaneous bacterial peritonitis

a network meta-analysis

Wang, Wanconga,*; Yang, Jiahuic,*; Liu, Chuana,*; Song, Panb; Wang, Wenzhena; Xu, Huimeid; Xia, Xingzhoua

European Journal of Gastroenterology & Hepatology: August 2019 - Volume 31 - Issue 8 - p 905–910
doi: 10.1097/MEG.0000000000001446
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For the prevention of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites, prophylactic antibiotics are recommended as a standard regimen. This study aimed to assess the efficacy of norfloxacin (N), ciprofloxacin (C), trimethoprim–sulfamethoxazole (T-S), and rifaximin (R) in the prevention of SBP. We searched the electronic databases including PubMed, Cochrane Library, Embase, and Web of Science from inception till 1 August 2018. The randomized-controlled trials that compared N, C, T-S, R, and placebo (P) were identified. A network meta-analysis (NMA) was carried out using the software STATA 14.0 and Revman 5.3. We included 16 studies involving 1984 participants in the NMA for SBP prevention. The NMA results showed that, compared with those treated with P (reference), patients treated with C, N, or R had a lower incidence of SBP and mortality. Similarly, the incidences of SBP and mortality for R were lower than those for N. The probabilities of ranking results showed that R ranked first with respect to the outcomes of the incidence of SBP and mortality. According to our results, R seemed to be the optimal regimen for protecting against SBP in patients with cirrhosis and ascites. However, considering the limitations of our study, additional high-quality studies are required in this respect.

aDepartment of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University

bDepartment of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou

cDepartment of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an

dDepartment of Gastroenterology, The Second Affiliated Hospital of Lanzhou University, Lanzhou, China

* Wancong Wang, Jiahui Yang and Chuan Liu contributed equally to the writing of this article.

Correspondence to Xingzhou Xia, MD, Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Kangfu Street No. 3, Zhengzhou 450000, China Tel/fax: +86 0371 6691 6970; e-mail: zhougxia@163.com

Received March 6, 2019

Accepted April 29, 2019

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