Gastroenterology
Volume 133, Issue 3 , Pages 818-824 , September 2007

Primary Prophylaxis of Spontaneous Bacterial Peritonitis Delays Hepatorenal Syndrome and Improves Survival in Cirrhosis

  • Javier Fernández

      Affiliations

    • Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain
    • ,
  • Miquel Navasa

      Affiliations

    • Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain
    • Corresponding Author InformationAddress requests for reprints to: Miquel Navasa, MD, Liver Unit, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. fax: (34) 93-4515522.
    • ,
  • Ramón Planas

      Affiliations

    • Gastroenterology Unit, Hospital Germans Trias i Pujol, Barcelona, Spain
    • ,
  • Silvia Montoliu

      Affiliations

    • Gastroenterology Unit, Hospital Germans Trias i Pujol, Barcelona, Spain
    • ,
  • David Monfort

      Affiliations

    • Gastroenterology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain
    • ,
  • German Soriano

      Affiliations

    • Gastroenterology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain
    • ,
  • Carmen Vila

      Affiliations

    • Gastroenterology Unit, Hospital del Mar, Barcelona, Spain
    • ,
  • Alberto Pardo

      Affiliations

    • Gastroenterology Unit, Hospital Universitario de Canarias, Tenerife, Spain
    • ,
  • Enrique Quintero

      Affiliations

    • Gastroenterology Unit, Hospital Universitario de Canarias, Tenerife, Spain
    • ,
  • Victor Vargas

      Affiliations

    • Gastroenterology Unit, Hospital Vall d’Hebron, Barcelona, Spain
    • ,
  • Jose Such

      Affiliations

    • Gastroenterology Unit, Hospital Universitario, Alicante, Spain
    • ,
  • Pere Ginès

      Affiliations

    • Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain
    • ,
  • Vicente Arroyo

      Affiliations

    • Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain

Received 19 December 2006 ,Accepted 17 May 2007.

References 

  1. Navasa M, Rimola A, Rodes J. Bacterial infections in liver disease. Semin Liver Dis. 1997;17:323–333
  2. Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garcia-Tsao G, et al. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut. 2005;54:718–725
  3. Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20:1495–1401
  4. Navasa M, Follo A, Filella X, Jimenez W, Francitorra A, Planas R, et al. Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality. Hepatology. 1998;27:1227–1232
  5. Ruiz-del-Arbol L, Urman J, Fernandez J, Gonzalez M, Navasa M, Monescillo A, et al. Systemic, renal and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003;38:1210–1218
  6. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–409
  7. Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990;12:716–724
  8. Rolanchon A, Cordier L, Bacq Y, Nousbaum JB, Franza A, Paris JC, et al. Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial. Hepatology. 1995;22:1171–1174
  9. Singh N, Gayowski T, Yu VL, Wagener MM. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial. Ann Intern Med. 1995;122:595–598
  10. Bauer TM, Follo A, Navasa M, Vila J, Planas R, Clemente G, et al. Daily norfloxacin is more effective than weekly rufloxacin in prevention of spontaneous bacterial peritonitis recurrence. Dig Dis Sci. 2002;47:1356–1361
  11. Sandhu BS, Gupta R, Sharma J, Singh J, Murthy NS, Sarin SK. Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites. J Gastroenterol Hepatol. 2005;20:599–605
  12. Grange JD, Roulot D, Pelletier G, Pariente EA, Denis J, Ink O, et al. Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial. J Hepatol. 1998;29:430–436
  13. Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology. 1986;91:1343–1346
  14. Llach J, Rimola A, Navasa M, Ginès P, Salmerón JM, Ginès A, et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. Hepatology. 1992;16:724–727
  15. Andreu M, Solá R, Sitges-Serra A, Alia C, Gallen M, Vila MC, et al. Risk factors for spontaneous bacterial peritonitis. Gastroenterology. 1993;104:1133–1138
  16. Guarner C, Solà R, Soriano G, Andreu M, Novella MT, Vila C, et al. Risk of a first community-acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels. Gastroenterology. 1999;117:414–419
  17. Ruiz-del-Arbol L, Monescillo A, Arocena C, Valer P, Ginès P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005;42:439–447
  18. Ginès A, Escorsell A, Ginès P, Salo J, Jimenez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105:229–236
  19. Bataller R, Gines P, Guevara M, Arroyo V. Hepatorenal syndrome. Semin Liver Dis. 1997;17:233–247
  20. Angeli P, Wong F, Watson H, Gines P CAPPS investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology. 2006;44:1535–1542
  21. Fernandez J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 2002;35:140–148
  22. Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis (International Ascites Club). Hepatology. 1996;23:164–176
  23. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document (International Ascites Club). J Hepatol. 2000;32:142–153
  24. Arroyo V, Terra C, Gines P. New treatments of hepatorenal syndrome. Semin Liver Dis. 2006;26:254–264
  25. Arroyo V, Rodes J, Gutierrez-Lizarraga MA, Revert L. Prognostic value of spontaneous hyponatremia in cirrhosis with ascites. Am J Dig Dis. 1976;21:249–256
  26. Planas R, Montoliu S, Balleste B, Rivera M, Miquel M, Masnou H, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006;4:1385–1394
  27. Albillos A, de la Hera A, Gonzalez M, Moya JL, Calleja JL, Monserrat J, et al. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement. Hepatology. 2003;37:208–217
  28. Rasaratnam B, Kaye D, Jennings G, Dudley F, Chin-Dusting J. The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis (A randomized trial). Ann Intern Med. 2003;139:186–193
  29. Llach J, Gines P, Arroyo V, Rimola A, Tito L, Badalamenti S, et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology. 1988;94:482–487
  30. Dupeyron C, Mangeney N, Sedrati L, Campillo B, Fouet P, Leluan G. Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis. Antimicrob Agents Chemother. 1994;38:340–344
  31. Aparicio JR, Such J, Pascual S, Arroyo A, Plazas J, Girona E, et al. Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences. J Hepatol. 1999;31:277–283
  32. Novella M, Solà R, Soriano G, Andreu M, Gana J, Ortiz J, et al. Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology. 1997;25:532–536
  33. Ortiz J, Vila MC, Soriano G, Miñana J, Gana J, Mirelis B, et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology. 1999;29:1064–1069

 Supported by grants from the Fondo de Investigación Sanitaria (FIS 00/0921) and the Instituto de Salud Carlos III (BEFI 00/9380 and C03/02).

 ClinicalTrials.gov number: NCT00359853.

PII: S0016-5085(07)01298-X

doi: 10.1053/j.gastro.2007.06.065

Gastroenterology
Volume 133, Issue 3 , Pages 818-824 , September 2007

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