The role of rifaximine in the prevention of the spontaneous bacterial peritonitis.

UNLABELLED: Cirrhosis is characterized by an increased susceptibility to infection. Spontaneous bacterial peritonitis (SBP) is the most common infectious complication, the main causes being the bowel bacterial overpopulation, the increased intestinal permeability and bacterial translocation. Antibiotic prophylaxis with Norfloxacin increases the rate of PBS with G+ multiresistant bacteria. PURPOSE: To demonstrate the advantage of using rifaximin, nonresorbable broad spectrum antibiotic, in SBP prophylaxy. MATERIAL AND METHODS: The study is a prospective case-control, which included 46 patients diagnosed with Child class C cirrhosis and refractory ascites, based on clinical, biological, ultrasound and endoscopic findings, followed over a period of 6 months. Protein level in ascitic fluid (AF) was higher 14 g/dl. SBP was defined as the presence of > 250 PMN/mm3. Patients were divided into 2 groups, group 1 comprised 22 patients who received rifaximin treatment during the study for a previous episode of hepatic encephalopathy (HE), and group 2 consisted of 24 patients who did not receive antibiotic treatment during follow-up. RESULTS: Rifaximin significantly decreases the polymorpho-nucleares (PMN) in ascitic fluid from patients, one single case of neutroascitic SBP with negative cultures were recorded in this group, with a net improvement of the general condition. In group 2 who did not follow any antibiotic treatment, SBP was recorded in 4 patients, an increase of PMN in ascitic fluid at 14 patients, an approximately constant value in 4 patients, a decrease in 2 subjects. CONCLUSIONS: The study suggests that rifaximin causes a significant decrease in PMN in AF, producing a decrease in SBP frequency and improvement of life in cirrhotic patients with refractory ascites. In this study, the effects of rifaximin on intestinal bacterial overpopulation and bacterial translocation, decisive factors in SBP, are consistent with literature data. Use of rifaximin as an alternative method to prevent SBP deserves more attention.