title: A randomized controlled study of trimethoprim-sulfamethoxazole versus norfloxacin for the prevention of infection in cirrhotic patients.
abstract: OBJECTIVE
  To prospectively compare norfloxacin (N) with trimethoprim-sulfamethoxazole (T-S) in preventing infection in cirrhotic patients.
  
  
  METHODS
  Cirrhotic patients at high risk of spontaneous bacterial peritonitis (SBP) were recruited and assigned N (400 mg daily) or T-S (160/800 mg daily). Patients were followed up for 12 months. The primary end-point was the incidence of infection. Secondary end-points included the incidence of SBP, bacteremia, extraperitoneal infection requiring antibiotic treatment, liver transplantation, death, side effects and rate of resistance to N or T-S.
  
  
  RESULTS
  A total of 80 patients with a mean age of 53.0 ± 9.3 years were prescribed N (n = 40) or T-S (n = 40). Child-Pugh status, model for end-stage liver disease and risk factors for SBP were similar between the groups. There were 10 episodes of infections in the N group and 9 in the T-S group (P = 0.79). Two patients each in the N and T-S group developed SBP (P = 0.60). There was a difference in the rate of transplantation favoring N (P = 0.03) but not death. The number of adverse events for N (n = 7) and T-S (n = 10) were similar (P = 0.59), with T-S being associated with an increased risk of developing a definite or probable adverse event compared to N (22.5% vs 0%, P = 0.01).
  
  
  CONCLUSIONS
  This study failed to demonstrate a difference between N and T-S groups in their effects on preventing infection in patients with liver cirrhosis. T-S can be considered an alternative first-line therapy for infection prophylaxis.
authors.affiliation: Department of Liver Transplant.
authors.forename: Steve
authors.initials: S
authors.lastname: Lontos
authors.forename: Edward
authors.initials: E
authors.lastname: Shelton
authors.forename: Peter W
authors.initials: PW
authors.lastname: Angus
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Roberts
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gow
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods; D016470:Bacteremia / Q000150:complications / Q000517:prevention & control; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009643:Norfloxacin / Q000008:administration & dosage*; D010538:Peritonitis / Q000150:complications / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009643:Norfloxacin
keywords: Trimethoprim-sulfamethoxazole combination; infection; liver cirrhosis; norfloxacin; prevention