Role of fluoroquinolones in the primary prophylaxis of spontaneous bacterial peritonitis: meta-analysis.
OBJECTIVE
The use of antibiotics in the primary prophylaxis for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis is controversial. Our purpose was to determine the beneficial effect of fluoroquinolones as compared with placebo in primary prophylaxis of SBP in high-risk patients with cirrhosis by using meta-analysis.


METHODS
Medline, Embase, Cochrane, and Web of Science databases were searched in all languages until August 2008 for randomized placebo-controlled studies evaluating the role of fluoroquinolones in primary prevention of SBP in patients with low protein ascites (total ascitic protein, <1.5 g/dL) and without history of SBP. Two investigators independently performed literature search and data extraction, and then another investigator independently reviewed whether the studies met prespecified criteria and rechecked data extraction. Odds ratios (Peto method) for the risk reduction with fluoroquinolones were calculated for each study and combined by using a random-effects model.


RESULTS
Four randomized controlled studies met predefined criteria. The odds ratios for developing first episode of SBP, serious infections, and mortality with fluoroquinolone prophylaxis (n = 194) versus placebo (n = 190) were 0.18 (95% confidence interval [CI], 0.09-0.35), 0.18 (95% CI, 0.10-0.32), and 0.60 (95% CI, 0.37-0.97), respectively. All studies were unidirectional in showing the beneficial effect of fluoroquinolone prophylaxis. We were limited by finding few studies with relatively small sample sizes.


CONCLUSIONS
Daily oral fluoroquinolone prophylaxis reduces the risk of development of first episode of SBP and mortality in cirrhotic patients with low total protein in the ascitic fluid. Fluoroquinolones might be advisable for the primary prophylaxis of SBP in selected high-risk patients with cirrhosis.
Loomba
Rohit
R
Division of Gastroenterology, University of California at San Diego, La Jolla, California. Electronic address: roloomba@ucsd.edu.
Wesley
Robert
R
Hospital Epidemiology, Clinical Center, National Institutes of Health, DHHS, Bethesda, Maryland.
Bain
Andrew
A
Division of Gastroenterology, University of California at San Diego, La Jolla, California.
Csako
Gyorgy
G
Department of Laboratory Medicine, Clinical Center, National Institutes of Health, DHHS, Bethesda, Maryland.
Pucino
Frank
F
Pharmacy Department, Clinical Center, National Institutes of Health, DHHS, Bethesda, Maryland.
D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy; D015233:Models, Statistical; D010538:Peritonitis / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
D024841:Fluoroquinolones