Impact of Quinolone Prophylaxis on Spontaneous Bacterial Peritonitis and Mortality in Cirrhosis Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

TL;DR

This study finds that using quinolone antibiotics to prevent infections in cirrhosis patients reduces the risk of serious complications and death.

Contribution

The study provides a meta-analysis confirming the effectiveness of quinolone prophylaxis in reducing SBP, non-SBP infections, and mortality in cirrhosis patients.

Findings

Quinolone prophylaxis significantly lowers the risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients.

The treatment also reduces non-SBP infections and overall mortality in these patients.

Sensitivity analysis confirms the robustness of the observed benefits.

Abstract

Cirrhosis is a major global health concern due to its progressive nature and high risk of complications, including spontaneous bacterial peritonitis (SBP), which significantly increases mortality. Quinolone antibiotics, especially norfloxacin, are commonly used for SBP prophylaxis in high‐risk cirrhotic patients, but the long‐term impact on overall mortality remains uncertain. The purpose of this meta‐analysis and systematic review is to evaluate how quinolone prophylaxis affects the SBP incidence, mortality, and non‐SBP infections in cirrhosis patients.

A comprehensive search of Web of Science, Embase, and PubMed identified research evaluating quinolone prophylaxis on the risk of spontaneous bacterial peritonitis (SBP) and mortality in cirrhotic patients. Inclusion criteria included randomized controlled trials reporting risk ratios for patients on quinolone prophylaxis versus controls. A random‐effects meta‐analysis pooled the results, with heterogeneity assessed by the I2 statistic. Sensitivity analyses were performed for robustness.

The search screened 1754 items and identified 6 relevant studies. Quinolone prophylaxis was associated with a significantly lower risk of spontaneous bacterial peritonitis (SBP), non‐SBP infections, and mortality in cirrhotic patients, with a pooled relative risk (RR) for SBP of 0.47 (95% CI: 0.22–1.01), for non‐SBP infections of 0.79 (95% CI: 0.66–0.94), and for mortality of 0.67 (95% CI: 0.52–0.86). Sensitivity analysis confirmed the robustness of these findings.

This meta‐analysis reveals that quinolone prophylaxis significantly lowers the risk of spontaneous bacterial peritonitis (SBP), other infections, and mortality in high‐risk cirrhotic patients. The results support incorporating quinolone prophylaxis in cirrhosis management to improve outcomes, with future studies needed to refine treatment duration and patient‐specific strategies.

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