Review Article

Safety and Efficacy of Rifaximin in Prophylaxis of Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-analysis

Author(s): Amr Menshawy, Omar Mattar, Kirolos Barssoum, Ammar M. AboEl-Naga, Haitham Mohamed Salim, Ahmed Mesbah Fahmy Mohamed, Ahmed Elgebaly and Sherief Abd-Elsalam*

Volume 20, Issue 4, 2019

Page: [380 - 387] Pages: 8

DOI: 10.2174/1389450119666180924145156

Price: $65


Aim: The role of rifaximin in the prevention of Spontaneous Bacterial Peritonitis (SBP) is not well studied. The aim of this meta-analysis was to evaluate the role of rifaximin in the prevention of SBP.

Methods: A computerized literature search for relevant clinical trials was conducted during August 2017. Data on Frequency of SBP, the success rate of prevention of SBP, mortality rate, hepatorenal syndrome, septic shock, hepatic encephalopathy, and GIT bleeding were extracted and pooled as Risk Ratio (RR) with their 95% Confidence Interval (CI) in a meta-analysis model. Heterogeneity was assessed by Chi-square test.

Results: Six studies involving 973 patients were included in the final analysis. The pooled effect estimate showed that the rifaximin plus norfloxacin group had less incidence of SBP (RR 0.58, 95% CI[0.37, 0.92], P=0.02) and hepatic encephalopathy (RR 0.38, 95% CI[0.17, 0.84], P=0.02) than the norfloxacin-based regimen group. No significant difference between rifaximin and norfloxacin in terms of frequency of SBP and success rate of primary prevention of SBP (RR 0.49, 95% CI [0.24, 1.01], P=0.05; RR1.21, 95% CI [0.95, 1.55], P=0.13, respectively).

Conclusion: Based on our analysis, Rifaximin is a promising drug and appears to be a good alternative to norfloxacin in the prevention of SBP.

Keywords: Rifaximin, norfloxacin, SBP, encephalopathy, prevention, hepatorenal syndrome.

Graphical Abstract
Elfert A, Abo Ali L, Soliman S, Ibrahim S, Abd-Elsalam S. Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2016; 28(12): 1450-4.
Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: Recent guidelines and beyond. Gut 2012; 61(2): 297-310.
Fernandez J, Navasa M, Gomez J, et al. Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2000; 35(1): 140-8.
Runyon BA, Squier S, Borzio M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol 1994; 21(5): 792-6.
Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension : Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Dig Dis 2016; 34(4): 382-6.
Fernández J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol 2012; 56(Suppl. 1): S1-S12.
Piroth L, Pechinot A, Di Martino V, Hansmann Y, Putot A, Patry I, et al. Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis : A two-year observational study. BMC Infect Dis 2014; 14: 287.
Kalambokis GN, Mouzaki A, Rodi M, Tsianos EV. Rifaximin for the prevention of spontaneous bacterial peritonitis. World J Gastroenterol 2012; 18(14): 1700-2.
Green S, Higgins PTJ, Alderson P, Clarke M, Mulrow DC, Oxman DA. Cochrane Handbook: Cochrane Reviews: Ch 8: Assessing risk of bias in included studies. In: Cochrane Handbook for: Systematic Reviews of Interventions. 2011; p. 3–10.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-34.
Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Stat Med 2003; 22(13): 2113-26.
Mostafa T, Badra G, Abdallah M. The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients. Turk J Gastroenterol 2015; 26(2): 163-9.
Assem M, Elsabaawy M, Abdelrashed M, Elemam S, Khodeer S, Hamed W, et al. Efficacy and safety of alternating norfloxacin and rifaximin as primary prophylaxis for spontaneous bacterial peritonitis in cirrhotic ascites: A prospective randomized open-label comparative multicenter study. Hepatol Int 2016; 10(2): 377-85.
Vlachogiannakos J, Viazis N, Vasianopoulou P, Vafiadis I, Karamanolis DG, Ladas SD. Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis. J Gastroenterol Hepatol 2013; 28(3): 450-5.
Shamseya MM, Madkour MA. Rifaximin: A reasonable alternative for norfloxacin in the prevention of spontaneous bacterial peritonitis in patients with HCV-related liver cirrhosis. Alexandria J Med 2016; 52(3): 219-26.
Lutz P, Parcina M, Bekeredjian-Ding I, et al. Impact of rifaximin on the frequency and characteristics of spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites. PLoS One 2014; 9(4)
Hanouneh MA, Hanouneh IA, Hashash JG, et al. The Role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis. J Clin Gastroenterol 2012; 46(8): 709-15.

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