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Meta-Analysis
. 2023 Aug 28;23(1):557.
doi: 10.1186/s12879-023-08557-6.

Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacteria peritonitis in cirrhosis: a systematic review and meta-analysis

Shuailing Song #  1 , Yi Yang #  2 , Chong Geng  1   3 , Zeya Tang  4 , Chunhui Wang  1 , Xiao Li  5
Affiliations
Meta-Analysis

Norfloxacin versus alternative antibiotics for prophylaxis of spontaneous bacteria peritonitis in cirrhosis: a systematic review and meta-analysis

Shuailing Song et al. BMC Infect Dis. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Norfloxacin; Primary prophylaxis; Rifaximin; Second prophylaxis; Spontaneous bacterial peritonitis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart diagram for study selection in meta-analysis. “impertinent” means not meeting the inclusion criteria
Fig. 2
Fig. 2
Forest plot of the overall incidence of SBP between the norfloxacin group and the other antibiotic group. SBP, spontaneous bacterial peritonitis
Fig. 3
Fig. 3
Forest plot of the incidence of SBP between the norfloxacin group and the other antibiotic group in the primary prophylaxis (a) and the secondary prophylaxis (b). SBP, spontaneous bacterial peritonitis
Fig. 4
Fig. 4
Forest plot of the morbidity
Fig. 5
Fig. 5
Forest plot of the overall infection
Fig. 6
Fig. 6
Forest plot of the adverse events
See this image and copyright information in PMC

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