Background: Spontaneous bacterial peritonitis is common and is associated with significant short-term mortality. Antibiotic prophylaxis is the mainstay preventive treatment, but there is concern about development of drug resistance and other adverse events. There is uncertainty regarding relative efficacy and optimal combination of the different available prophylactic treatments.
Study design: 29 randomized clinical trials.
Synopsis: Across 29 randomized clinical trials (total of 3,896 participants) looking at nine different antibiotic regimens for prophylaxis of spontaneous bacterial peritonitis, there was no evidence of differences between any of the antibiotics and no intervention in terms of mortality or serious adverse events, though there was very low certainty of evidence. The authors felt only two small studies were conducted without flaws. There was no difference between any of the antibiotics and no intervention in the proportion of people who developed spontaneous bacterial peritonitis. Overall, 10% of trial participants developed spontaneous bacterial peritonitis and 15% of trial participants died. The lack of effectiveness of across several outcomes may be because of sparse data and selective reporting bias.
Bottom line: Whether antibiotics are effective prophylaxis to prevent spontaneous bacterial peritonitis and which antibiotics should be used is still uncertain; future well-designed studies are needed.
Citation: Komolafe O et al. Antibiotic prophylaxis to prevent spontaneous bacterial peritonitis in people with liver cirrhosis: A network meta-analysis. Cochrane Database Syst Rev. 2020 Jan 16;1:CD013125. doi: 10.1002/14651858.CD013125.pub2.
Dr. Millard is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.