Safety and Efficacy of Rifaximin in Prophylaxis of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Systematic Review and Meta-Analysis

Science Center A254

There is inadequate evidence about the use of rifaximin and norfloxacin as primary prophylaxis for spontaneous bacterial peritonitis (SBP). Therefore, the purpose of this systematic review and meta-analysis is to compare the efficacy and safety of alternating rifaximin and norfloxacin in the primary prophylaxis of SBP. A computerized literature search for relevant clinical trials was conducted during August 2017. Data on frequency of SBP, the success rate of primary prevention of SBP, mortality rate, hepatorenal syndrome, septic shock, hepatic encephalopathy, and GIT bleeding were extracted and pooled as risk ratio (RR) with their 95% confidence interval (CI) in a meta- analysis model. Heterogeneity was assessed by a Chi-square test. Six studies involving 973 patients were included in the final analysis. The pooled effect estimate showed that the rifaximin plus norfloxacin group had less incidence of SBP (RR 0.58, 95% CI [0.37, 0.92], P=0.02) and hepatic encephalopathy (RR 0.38, 95% CI [0.17, 0.84], P=0.02) than the norfloxacin-based regimen group. In addition, the rifaximin plus norfloxacin group was superior to the norfloxacin group in terms of success rate of primary prevention of SBP (RR 1.32, 95% CI [1.05, 1.67], P=0.02). Norfloxacin was superior to rifaximin in terms of mortality rate (RR 0.61, 95% CI [0.40, 0.93], P=0.02) and hepatic encephalopathy (RR 0.42, 95% CI [0.20, 0.89], P=0.02). However, there was no significant difference between rifaximin and norfloxacin in terms of frequency of SBP and success rate of primary prevention of SBP (RR 0.49, 95% CI [0.24, 1.01], P=0.05; RR 1.21, 95% CI [0.95, 1.55], P=0.13, respectively). Also, the pooled estimate favored neither rifaximin plus norfloxacin nor rifaximin over norfloxacin monotherapy in terms of hepatorenal syndrome, septic shock, and git bleeding. Based on our analysis, rifaximin and norfloxacin based primary prophylaxis for SBP had less SBP, less hepatic encephalopathy, and more primary prevention of SBP than norfloxacin monotherapy. Both regimens were similar in safety outcomes.