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Fluoroquinolones Show Benefit in Certain Cirrhosis Patients

Prophylaxis may prevent bacterial peritonitis in those with low total protein in ascitic fluid

TUESDAY, April 14 (HealthDay News) -- Daily oral fluoroquinolone prophylaxis may reduce the risk of spontaneous bacterial peritonitis (SBP) and other adverse outcomes in patients with cirrhosis and low total protein in the ascitic fluid, according to research published in the April Clinical Gastroenterology and Hepatology.

Rohit Loomba, M.D., of the University of California at San Diego in La Jolla, and colleagues conducted a meta-analysis of four randomized controlled studies comparing fluoroquinolones versus placebo in patients at high risk for a first episode of SBP due to low ascitic fluid protein levels.

Patients receiving fluoroquinolone prophylaxis had lower odds of developing a first episode of SBP (odds ratio, 0.18) and serious infections (odds ratio, 0.18), and they had a lower risk of mortality (odds ratio, 0.60), the investigators found. The numbers needed to treat in order to prevent an episode of SBP or death were 7 and 12, respectively.

"Most experts believe that bacterial translocation across the gut might be the underlying mechanism responsible for increased rate of infection in patients with low total protein ascites. This hypothesis is also supported by the fact that enteric pathogens, especially gram-negative bacteria, are the leading causes of infection in patients with ascites and cirrhosis," the authors write. "Therefore, it is plausible that the use of antibiotics that are active against gram-negative pathogens such as norfloxacin and ciprofloxacin might lead to reduction in the infection rate in this subset of patients."

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