Systemic review and network meta-analysis:Prophylactic antibiotic therapy for spontaneous bacterial peritonitis

• 作者: Akihiro Yamada Atsushi Sakuraba Dejan Micic Fukiko Komaki Haider Haider Nolan Faust Yuga Komaki
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Spontaneous bacterial peritonitis PROPHYLAXIS ANTIBIOTICS Network metaanalysis Systemic review CIRRHOSIS
• 年，卷（期）: sjgbxzzywbdzb_2020,（5）
• 页码范围: 239-252
• 页数: 14页
• 分类号: R73

摘要

BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choice of antibiotics remains unclear.AIM To evaluate the efficacy of various antibiotics for prophylaxis of SBP based on randomized control trials(RCTs).METHODS Electronic databases were searched through November 2018 for RCTs evaluating the efficacy of therapies for primary or secondary prophylaxis of SBP.The primary outcome was the development of SBP.Sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010 were performed.The secondary outcome was the risk of all-cause mortality or transplant.The outcomes were assessed by rank of therapies based on network meta-analyses.Individual meta-analyses were also performed.RESULTS Thirteen RCTs(1742 patients)including norfloxacin,ciprofloxacin,rifaximin,trimethoprim-sulfamethoxazole(TMP-SMX),or placebo/no comparator were identified.Individual meta-analyses showed superiority of rifaximin over norfloxacin as well as norfloxacin and TMP-SMX over placebo.Network metaanalysis demonstrated the rank of efficacy in reducing the risk of SBP as:Rifaximin,ciprofloxacin,TMP-SMX,norfloxacin,and placebo/no comparator.Rifaximin ranked highest in sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010.Similarly,rifaximin ranked highest in reducing the risk of death/transplant.CONCLUSION The present comprehensive network meta-analysis provides RCT based evidence for superior efficacy of rifaximin compared to other antibiotics for the prophylaxis of SBP and reducing risk of death/transplant.Further RCTs are warranted to confirm our findings.