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Prophylactic Antibiotic May Help in Advanced Cirrhosis

Treatment reduces risks of spontaneous bacterial peritonitis and hepatorenal syndrome

TUESDAY, Sept. 18 (HealthDay News) -- In patients with advanced cirrhosis, primary prophylaxis with norfloxacin may reduce the risk of peritonitis and other complications and improve survival, researchers report in the September issue of Gastroenterology.

Miquel Navasa, M.D., of the Hospital Clinic Barcelona's Liver Unit in Barcelona, Spain, and colleagues randomly assigned 68 patients with cirrhosis, low protein ascitic levels and advanced liver failure or impaired renal function to receive either norfloxacin or placebo.

Subjects in the norfloxacin group were less likely than the placebo group to develop spontaneous bacterial peritonitis (7 percent versus 61 percent) and hepatorenal syndrome (28 percent versus 41 percent). They also found that the norfloxacin group had higher rates of survival at three months (94 percent versus 61 percent) and at one year (60 percent versus 48 percent).

"We should reserve use of selective intestinal decontamination for patients who meet the inclusion criteria of the randomized trials," cautions the author of an accompanying editorial. "There are disadvantages to selective intestinal decontamination. Prolonged exposure to quinolones pre-transplant was shown to be a risk factor for post-transplant fungal infections in a prospective study. The risks must be weighed against the benefits when the use of any drug is being considered in patients with advanced cirrhosis."

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