scholarly journals Antibiotic prophylaxis for prevention of spontaneous bacterial peritonitis in liver cirrhosis: systematic review

2021 ◽  
Vol 84 (2) ◽  
pp. 333-342
Author(s):  
R Pimentel ◽  
C Gregório ◽  
P Figueiredo
Keyword(s):  
Systematic Review ◽  
Liver Cirrhosis ◽  
Spontaneous Bacterial Peritonitis ◽  
Secondary Prophylaxis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Cirrhotic Patients

Background and aim: Spontaneous bacterial peritonitis is a potentially life-threatening infection in patients with liver cirrhosis and ascites. Its prevention is vital to improve prognosis of cirrhotic patients. The main objective of this systematic review was to evaluate what is the most efficacious and safest antibiotic prophylactic strategy. Methods: Studies were located by searching PubMed and Cochrane Central Register of Controlled Trials in The Cochrane Library until February 2019. Randomized controlled trials evaluating primary or secondary spontaneous bacterial peritonitis prophylaxis in cirrhotic patients with ascites were included. The selection of studies was performed in two stages: screening of titles and abstracts, and assessment of the full papers identified as relevant, considering the inclusion criteria. Data were extracted in a standardized way and synthesized qualitatively. Results: Fourteen studies were included. This systematic review demonstrated that daily norfloxacin is effective as a prophylactic antibiotic for the prevention of spontaneous bacterial peritonitis in patients with cirrhosis. Once weekly ciprofloxacin was not inferior to once daily norfloxacin, with good tolerance and no induced resistance. Trimethoprim-sulfamethoxazole and norfloxacin have similar efficacy for primary and secondary prophylaxis of spontaneous bacterial peritonitis, however, trimethoprim-sulfamethoxazole was associated with an increased risk of developing an adverse event. Rifaximin was more effective than norfloxacin in the secondary prophylaxis of spontaneous bacterial peritonitis, with a significant decrease in adverse events and mortality rate. Conclusions: Continuous long-term selective intestinal decontamination with norfloxacin is the most widely used prophylactic strategy in spontaneous bacterial peritonitis, yet other equally effective and safe options are available.

scholarly journals The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 964
Author(s):  
Irina Girleanu ◽  
Anca Trifan ◽  
Laura Huiban ◽  
Cristina Muzica ◽  
Roxana Nemteanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Spontaneous Bacterial Peritonitis ◽  
Real Life ◽  
Secondary Prophylaxis ◽  
Cox Regression Analysis ◽  
Bacterial Peritonitis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Cirrhotic Patients

Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI and the risk factors in cirrhotic patients with a previous episode of SBP receiving norfloxacin as secondary prophylaxis. Materials and Methods: We performed a prospective, cohort study including patients with liver cirrhosis and SBP, successfully treated over a 2-year period in a tertiary university hospital. All the patients received secondary prophylaxis for SBP with norfloxacin 400 mg/day. Results: There were 122 patients with liver cirrhosis and SBP included (mean age 57.5 ± 10.8 years, 65.5% males). Alcoholic cirrhosis was the major etiology accounting for 63.1% of cases. The mean MELD score was 19.7 ± 6.1. Twenty-three (18.8%) of all patients developed CDI during follow-up, corresponding to an incidence of 24.8 cases per 10,000 person-years. The multivariate Cox regression analysis demonstrated that alcoholic LC etiology (HR 1.40, 95% CI 1.104–2.441, p = 0.029) and Child-Pugh C class (HR 2.50, 95% CI 1.257–3.850, p = 0.034) were independent risk factors for CDI development during norfloxacin secondary prophylaxis. The development of CDI did not influence the mortality rates in cirrhotic patients with SBP receiving norfloxacin. Conclusions: Cirrhotic patients with SBP and Child-Pugh C class and alcoholic liver cirrhosis had a higher risk of developing Clostridioides difficile infection during norfloxacin secondary prophylaxis. In patients with alcoholic Child-Pugh C class liver cirrhosis, alternative prophylaxis should be evaluated as SBP secondary prophylaxis.

scholarly journals Ear Acupressure for Allergic Rhinitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-20
Author(s):  
Juan Zhong ◽  
Shuqin Liu ◽  
Dan Lai ◽  
Tao Lu ◽  
Yifeng Shen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Randomized Controlled Trials ◽  
Symptom Score ◽  
Latin American ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled

Background. The treatment effects and safety of ear acupressure (EAP) for patients with allergic rhinitis (AR) have yet to be clarified. Objective. To evaluate the effects and safety of EAP in AR patients. Design. Systematic review of published studies. Methods. A total of 24 English and Chinese databases (PubMed, EMBASE (Excerpta Medical Database), Cochrane Central Register of Controlled Trials, CINAHL, Informit, ScienceDirect, LILACS (Latin American and Caribbean Health Sciences), ProQuest, AMED, Blackwell Synergy, PsycINFO, Panteleimon, AcuBriefs, KoreaMed, IndMed, Ingenta, mRCT, ISI Web of Knowledge, ERIC, VIP Information (http://www.cqvip.com), China National Knowledge Infrastructure (http://www.cnki.net), Cochrane Library, Chinese Cochrane Centre Controlled Trials Register Platform, and Wanfang Chinese Digital Periodical and Conference Database) were searched from their respective inceptions to August 2020 to collect randomized controlled trials of ear acupressure for allergic rhinitis. We performed literature inclusion, data extraction, and trial quality evaluations. Methodological quality was assessed according to the Cochrane Handbook. Revman5.3 was used for all analyses. Results. A total of 203 trials were identified and eleven studies involved 1094 participants aged 3–70 years. EAP was better than control group interventions in terms of effectiveness (risk ratio (RR): 0.51; 95% confidence interval (CI): 0.36–0.70; P < 0.0001 ). EAP was superior to sham EAP in terms of improvement of the total nasal symptom score (RR: −0.50; 95% CI: −0.96–0.05; P = 0.03), sneezing score (RR: −0.36; 95% CI: −0.59–0.12; P = 0.003), global QoL score (RR: 0.42; 95% CI: 0.04–0.08; P = 0.03), and eye symptom score (RR: −0.36; 95% CI: −0.67–0.05; P = 0.02). Conclusions. Despite the positive results, it is premature to confirm the efficacy of EAP for treating AR. More high-quality studies are needed to confirm safety and efficacy.

scholarly journals Pharmacotherapy of liver cirrhosis and its complications

2021 ◽  
pp. 23-27
Author(s):  
T. M. Bentsa
Keyword(s):  
Liver Cirrhosis ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Beta Blockers ◽  
Bleeding Risk ◽  
Refractory Ascites ◽  
Variceal Hemorrhage ◽  
Bacterial Peritonitis ◽  
Treatment And Prevention ◽  
Increased Risk

This article provides information about the pharmacotherapy of liver cirrhosis (LC) and its complications, such as variceal hemorrhage, ascites, increased risk of bacterial infection, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome LC is a major healthcare problem and is associated with an increased mortality due to the development of complications. LC is currently the 11th most common cause of death globally. Prognosis of LC is highly variable and influenced by several variables, such as etiology, severity of liver disease, presence of complications and comorbidities. In advanced cirrhosis, survival decreases to one or two years. Pharmacotherapy for LC should be implemented in accordance with up-to-date guidelines and in conjunction with aetiology management, nutritional optimisation and patient education. The main treatment of uncomplicated ascites is diuretics such as spironolactone in combination with a loop diuretic. For treatment refractory ascites vasoconstrictors and albumin are recommended. Antibiotics play a well-established role in the treatment and prevention of spontaneous bacterial peritonitis. For hepatorenal syndrome, the administration of vasopressor terlipressin and albumin is recommended. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices). A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Non-selective beta-blockers effectively reduce variceal re-bleeding risk in LC patients with moderate/large varices. Thus, the treatment of LC as one of the most formidable multiorgan pathologies involves a comprehensive approach aimed at the correction of the main pathology and the treatment and prevention of its complications.

Patient education for preventing recurrence of venous leg ulcers: a systematic review

2020 ◽  
Vol 29 (2) ◽  
pp. 79-91 ◽  
Author(s):  
Emer Shanley ◽  
Zena Moore ◽  
Declan Patton ◽  
Tom O’Connor ◽  
Linda Nugent ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Education ◽  
Small Sample ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
The Impact

Objective: To investigate the impact of patient education interventions on preventing the recurrence of venous leg ulcers (VLU). Method: A systematic review was undertaken using the following databases: Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library); Ovid; Ovid (In-process and Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL. Trial registries and reference lists of relevant publications for published and ongoing trials were also searched. There were no language or publication date restrictions. Randomised controlled trials (RCTs) and cluster RCTs of patient educational interventions for preventing VLU recurrence were included. Review authors working independently assessed trials for their appropriateness for inclusion and for their risk of bias, using pre-determined inclusion and quality criteria. Results: A total of four studies met the inclusion criteria (274 participants). Each trial explored different interventions as follows: the Lively legs programme; education delivered via a video compared with education delivered via a pamphlet; the Leg Ulcer Prevention Programme and the Lindsay Leg Club. Only one study reported the primary outcome of incidence of VLU recurrence. All studies reported at least one of the secondary outcomes: patient behaviours, patient knowledge and patient quality of life (QoL). It is uncertain whether patient education programmes make any difference to VLU recurrence at 18 months (risk ratio [RR]: 0.82; 95% confidence interval: [CI] 0.59 to 1.14) or to patient behaviours (walked at least 10 minutes/five days a week RR: 1.48; 95%CI: 0.99 to 2.21; walked at least 30 minutes/five days a week: RR 1.14; 95%CI: 0.66 to 1.98; performed leg exercises: RR: 1.47; 95%CI: 1.04 to 2.09); to knowledge scores (MD (mean difference) 5.12, 95% CI –1.54 to 11.78); or to QoL (MD: 0.85, 95% CI –0.13 to 1.83), as the certainty of evidence has been assessed as very low. It is also uncertain whether different types of education delivery make any difference to knowledge scores (MD: 12.40; 95%CI: –5.68 to 30.48). Overall, GRADE assessments of the evidence resulted predominantly in judgments of very low certainty. The studies were at high risk of bias and outcome measures were imprecise due to wide CIs and small sample sizes. Conclusion: It is uncertain whether education makes any difference to the prevention of VLU recurrence. Therefore, further well-designed trials, addressing important clinical, QoL and economic outcomes are justified, based on the incidence of the problem and the high costs associated with VLU management.

Sign in / Sign up

Export Citation Format

Share Document