Comparison of Efficacy of Rifaximin and Norfloxacin in Prevention of Spontaneous Bacterial Peritonitis

ABSTRACT

Background:Norfloxacin is the most commonly used agent for the prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Rifaximin, another broad spectrum antibiotic, is used for the treatment of traveler’s diarrhea and hepatic encephalopathy. Objective: We aimed to test the efficacy of rifaximin versus norfloxacin for prevention of SBP in patients with hepatitis C virus (HCV)-related liver cirrhosis. Methods: 100 patients with HCV-related liver cirrhosis and ascites were included in study and divided into two groups of matching age, sex and Child–Pugh class. Group I patients were given norfloxacin 400 mg/day and group II patients were given total dose of rifaximin 1200 mg/day in three divided doses. The follow up time was one year. Results:Patients on rifaximin developed fewer episodes of SBP than those on norfloxacin (8% vs 16% respectively) although it was statistically insignificant (p=0.265). Also, the duration before developing a new attack of SBP was longer in patients treated with rifaximin as compared to those taking norfloxacin (9.0 vs. 5.5 months, respectively). Additionally, rifaximin significantly reduced the rate of new compared to past episodes of SBP by 24% (p while the rate reduction with norfloxacin was only by 18% and not statistically significant (p= 0.45). Overall survival was equal in both groups. Conclusion: Rifaximin is – at least – as good as norfloxacin. It seems to be an appropriate alternative for long-term primary and secondary prophylaxis of SBP in cirrhotic patients with ascites.