Antibiotic prophylaxis in cirrhotic patients without gastro-intestinal bleeding

Antibiotic prophylaxis may prevent spontaneous bacterial peritonitis and improve survival in cirrhotic patients with ascites and without gastro-intestinal bleeding.

A Cochrane review included 9 studies with a total of 674 subjects. The reported mean follow-up times varied between 25 and 204 days; 2 studies followed-up the patients for 1 year. 7 studies comparing antibiotics to placebo or no treatment were meta-analysed. 2 additional studies evaluated the effects of antibiotics compared with a different regimen of antibiotics. Antibiotic prophylaxis decreased spontaneous bacterial peritonitis (RR 0.20, 95% CI 0.11 to 0.37; 7 studies, n=538) and mortality (RR 0.61, 95% CI 0.43 to 0.87; 7 studies, n=538) compared with placebo or no treatment. Of control patients, 21% (95% CI 16% to 27%) experienced at least one event of spontaneous bacterial peritonitis. The NNT is 5.9 patients in order to prevent an event of spontaneous bacterial peritonitis. There were very few reports of adverse events.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by possible reporting bias.

Ədəbiyyat

1. Cohen MJ, Sahar T, Benenson S, Elinav E, Brezis M, Soares-Weiser K. Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleeding. Cochrane Database Syst Rev 2009;(2):CD004791.