Rifaximin for the Secondary Prevention of Spontaneous Bacterial Peritonitis Recurrence in Cirrhotic Patients
- Conditions
- Spontaneous Bacterial Peritonitis
- Interventions
- Registration Number
- NCT02011841
- Lead Sponsor
- Seoul National University Hospital
- Brief Summary
The aim of this study is to evaluate whether long-term rifaximin administration reduces spontaneous bacterial peritonitis recurrence rate in cirrhotic patients.
- Detailed Description
* Rifaximin is an antibiotic with a broad-spectrum activity against gram-positive and gram-negative microorganisms, both aerobes and anaerobes within the gastrointestinal tract. The main advantage of rifaximin is that it is poorly absorbable, which minimizes the antimicrobial resistance and adverse events and renders the drug safe in all patient populations. In addition, rifaximin has a better activity against gram-positive organisms than norfloxacin.
* 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. Theoretically, by reducing the total number of the gut bacteria, rifaximin could also be used to achieve intestinal decontamination in patients with liver cirrhosis and ascites, thus preventing spontaneous bacterial peritonitis.
* A small retrospective study concluded that rifaximin suppresses intestinal bacterial overgrowth, bacterial translocation in cirrhotic patients with ascites with no history of previous spontaneous bacterial peritonitis episodes. Prospective clinical trials are warranted to evaluate the role of rifaximin for prevention of spontaneous bacterial peritonitis recurrence in cirrhotic patients.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Patients diagnosed with cirrhosis based on clinical, biochemical, ultrasonographic and/or histological criteria
- Patients who had recovered from an episode of spontaneous bacterial peritonitis
- Age > 18 and <80 years
-
Decompensated cirrhotic patients with
- serum bilirubin > 3.2 mg/dL
- prothrombin time < 25%
- serum creatinine > 3 mg/dL
-
Active gastrointestinal bleeding
-
Hepatic encephalopathy > grade 2
-
Patients who have clinical, biochemical or radiological data suggesting hepatocellular carcinoma
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Control group Ciprofloxacin Ciprofloxacin 500 mg/day orally for 6 months Rifaximin group Rifaximin Rifaximin 1200 mg/day orally for 6 months
- Primary Outcome Measures
Name Time Method The recurrence rate of spontaneous bacterial peritonitis every 4 weeks, up to 24 weeks The proportion of patients who recurred spontaneous bacterial peritonitis.
- Secondary Outcome Measures
Name Time Method Causative bacteria of recurrent spontaneous bacterial peritonitis every 4 weeks, up to 24 weeks Causative bacteria of recurrent spontaneous bacterial peritonitis and susceptibility
Infections other than spontaneous bacterial peritonitis every 4 weeks, up to 24 weeks Infections other than spontaneous bacterial peritonitis (i.e. urinary tract infection, respiratory tract infection, etc.)
The recurrence of culture-negative spontaneous bacterial peritonitis every 4 weeks, up to 24 weeks The proportion of patients who recurred culture-negative spontaneous bacterial peritonitis.
Change of gut microbiota at baseline, week 12 Gut microbiota will be analyzed at baseline and week 12
mortality up to 24 weeks All-cause mortality and cause-specific mortality (mortality due to spontaneous bacterial peritonitis)
Trial Locations
- Locations (1)
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of