Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study.
OBJECTIVE
Low protein concentration in ascitic fluid has been identified as a risk factor for spontaneous bacterial peritonitis (SBP). Until now, primary prophylaxis has not been recommended in these patients. The aim was to investigate the efficacy of long-term administration of ciprofloxacin to prevent SBP.


METHODS
One hundred cirrhotic patients with <1.5 g/dl of total protein in ascitic fluid were randomized prospectively, in a double blind fashion to receive ciprofloxacin 500 mg/day (n=50) or placebo (n=50) for 12 months.


RESULTS
Baseline data were similar in both groups. In the ciprofloxacin group, SBP occurred almost four times less frequently than in the placebo group but it was not statistically significant. The probability of survival at 12 months was significantly higher in patients receiving ciprofloxacin (86% versus 66%) (p<0.04). SBP and sepsis were the most frequent causes of death in the placebo group whereas gastrointestinal bleeding was responsible for the most deaths in the ciprofloxacin group. The probability of remaining free of bacterial infections was higher in patients receiving ciprofloxacin (80% versus 55%) (p=0.05).


CONCLUSIONS
Patients with cirrhosis and low protein concentration in ascitic fluid are candidates to receive long-term prophylaxis to reduce the risk of infections and improve survival.
Terg
Rubén
R
Unidad de Hígado, Hospital de Gastroenterología Dr. Bonorino Udaondo, Sección Hepatología, Avenida Caseros 2061, 1264 Buenos Aires, Argentina. fundhig@speedy.com.ar
Fassio
Eduardo
E
Guevara
Mónica
M
Cartier
Mariano
M
Longo
Cristina
C
Lucero
Romina
R
Landeira
Cristina
C
Romero
Gustavo
G
Dominguez
Nora
N
Muñoz
Alberto
A
Levi
Diana
D
Miguez
Carlos
C
Abecasis
Raquel
R
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D002939:Ciprofloxacin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy* / Q000401:mortality
D000890:Anti-Infective Agents; D002939:Ciprofloxacin