title: The role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis.
abstract: BACKGROUND
  Primary prophylaxis of spontaneous bacterial peritonitis (SBP) may provide a survival advantage in cirrhotic patients with ascites and has become an integral part of clinical practice. Rifaximin is a poorly absorbable antibiotic with a broad spectrum of antibacterial action and has low risk of introducing bacterial resistance.
  
  
  OBJECTIVE
  To determine whether rifaximin is associated with decreasing the risk of SBP and improving transplant-free survival in cirrhotic patients with ascites.
  
  
  METHODS
  The medical records of all adult patients with liver cirrhosis and large ascites justifying paracentesis evaluated in our clinic (2003 to 2007) were reviewed. Patients were stratified into 2 groups by the use of rifaximin. Patients were excluded if they had received another antibiotic for SBP prophylaxis or had a history of SBP before rifaximin therapy.
  
  
  RESULTS
  A total of 404 patients were included, of whom 49 (12%) received rifaximin. The rifaximin and nonrifaximin groups were comparable with regards to age, sex, and race. The median follow-up time was 4.2 [1.0, 17.1] months. During this time period, 89% of patients on rifaximin remained SBP free compared with 68% of those not on rifaximin (P=0.002). After adjusting for Model of End-Stage Liver Disease score, Child-Pugh score, serum sodium, and ascitic fluid total protein, there was a 72% reduction in the rate of SBP in the rifaximin group (hazard ratio=0.28; 95% confidence interval, 0.11-0.71; P=0.007). The group treated with rifaximin also demonstrated a transplant-free survival benefit compared with those not on rifaximin (72% vs. 57%, P=0.045).
  
  
  CONCLUSIONS
  Intestinal decontamination with rifaximin may prevent SBP in cirrhotic patients with ascites. Prospective randomized controlled trials are needed to confirm this finding.
authors.affiliation: Department of Gastroenterology and Hepatology, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Hanouneh
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Hanouneh
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
authors.forename: Jamak Modaresi
authors.initials: JM
authors.lastname: Esfeh
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Nyla
authors.initials: N
authors.lastname: Hazratjee
authors.forename: Thomas
authors.initials: T
authors.lastname: Smith
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Zein
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D012294:Rifamycins; D000078262:Rifaximin