The Role of Rifaximin in Treatment of Spontaneous BacterialPeritonitisin Comparison to Standard Treatment

Abstract

Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. An early diagnosis of SBP and, specially, the use of a more adequate antibiotic therapy, are the most probable reasons for the improvement in prognosis for SBP. However, despite the resolution of the infection, the mortality rate of SBP is still high (30%), due mainly to the development of some complications such as renal impairment, gastrointestinal bleeding and progressive liver failure. Cirrhotic patients recovering from an episode of SBP should be considered as potential candidates for liver transplantation because the survival expectancy after this bacterial infection is very poor. Rifaximin is a poorly absorbable antibiotic with a broad spectrum of antibacterial action covering gram-positive and gram-negative organisms, both aerobes and anaerobes, and has a low risk of introducing bacterial resistance. The appreciation of the potential role of enteric flora in the pathogenesis of several gastrointestinal diseases has broadened the clinical use of rifaximin, which is now used for hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease, and Clostridium difficile infection. A study by Hanouneh et al. concluded that rifaximin seems to be an appropriate antibiotic for long-term primary prophylaxis of SBP in cirrhotic patients with ascites. The aim of this research was to examine the effect of rifaximin as an additional treatment to the standard treatment of SBP. This study included 60 patients, who are divided into two groups randomly, Group A included 30 patients received rifaximin at a dose of 1200 mg per day (400mg PO TID) and Summary 184 cefotaxime at a dose of 2 g IV every 12 hours, and Group B included 30 patients started cefotaxime alone as a control group. Each patient received his scheduled medication for 5 days. All patients included in our study were subjected to full history taking & clinical examination including both child-Pugh, and MELD score Evaluation, laboratory investigation including liver function tests, coagulation profile, complete blood picture, alpha feto protein, pelvi-abdominal ultrasound and ascetic fluid biochemical and microbiological analysis and bacteriological culture. After 5 days of drug intake, each patient was assessed for full clinical examination including both child-Pugh, and MELD score Evaluation, complete blood picture, Liver profile, kidney functions, complete blood picture and coagulation profile. As regard Group B serum electrolytes showed significant elevation in serum potassium level (but within physiological levels) with no other significant changes in serum sodium BUN or serum creatinine. However, liver function tests showed significant improvement in the level of direct bilirubin level, albumin total serum proteins, ALT level, PT and INR with non-significant change in total bilirubin and AST level. Hematological profile showed significant decrease in WBC count with non-significant effect on hemoglobin level. As regard Group A Child-Pugh and MELD scores show significant decrease, serum electrolytes showed significant decrease in serum potassium level with no other significant changes in serum sodium, BUN or serum creatinine. However, liver function tests showed significant improvement in the level of total bilirubin level, direct bilirubin level, albumin total serum proteins, AST, ALT level, PT and INR. Hematological profile showed significant decrease in WBCs count with non-significant effect on hemoglobin level. Also, the grade of ascites showed