What are possible adverse effects of prophylaxis for spontaneous bacterial peritonitis (SBP)?

Updated: Nov 26, 2018
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

A 2012 guideline from the American Association for the Study of Liver Diseases recommends that adult cirrhotic patients who have survived an episode of SBP should receive long-term prophylaxis with norfloxacin or trimethoprim-sulfamethoxazole. [19] However, long-term prophylaxis with norfloxacin is a risk factor for infection with a multi-resistant organism. [23]

However, mounting evidence shows that use of PPIs and selective-intestinal decontamination leads to development of increased pathogenic and drug-resistant flora. [24] In addition, despite evidence suggesting that primary prophylaxis of spontaneous bacterial peritonitis delays the development of hepatorenal syndrome and improves survival, a prospective study showed that patients with spontaneous bacterial peritonitis on long-term norfloxacin subsequently developed quinolone-resistant spontaneous bacterial peritonitis. [25]


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