From the Guidelines
Ciprofloxacin is used for spontaneous bacterial peritonitis (SBP) prophylaxis, particularly in patients who have recovered from an episode of SBP or are at high risk of developing SBP. According to the most recent guidelines on the management of ascites in cirrhosis 1, patients who have recovered from an episode of SBP should be considered for treatment with norfloxacin, ciprofloxacin, or co-trimoxazole to prevent further episodes of SBP. The recommended dose of ciprofloxacin for SBP prophylaxis is 500 mg once daily, orally 1. Key indications for SBP prophylaxis include:
- Prior episode of SBP
- Gastrointestinal bleeding
- Low ascitic fluid protein (<1.5 g/dL) with advanced liver disease or renal dysfunction Some studies have shown that ciprofloxacin can improve survival and reduce the risk of developing SBP in high-risk patients 1. However, it's essential to consider local resistance patterns and adjust the choice of antibiotic accordingly, as increasing fluoroquinolone resistance has become a concern. Patients on long-term prophylaxis should be monitored for adverse effects and development of resistant organisms. In terms of primary prophylaxis, ciprofloxacin (500 mg/day) has been shown to improve the one-year probability of survival and reduce the risk of developing SBP in patients with ascitic fluid total protein level <15 g/l 1. Overall, ciprofloxacin is a viable option for SBP prophylaxis, but its use should be guided by individual patient risk factors and local resistance patterns.
From the Research
Ciprofloxacin for Spontaneous Bacterial Peritonitis Prophylaxis
- Ciprofloxacin is a fluoroquinolone antibiotic that has been studied for its effectiveness in preventing spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.
- A prospective controlled trial published in 1995 2 found that long-term administration of ciprofloxacin (750 mg once a week for 6 months) significantly decreased the incidence of SBP and duration of hospitalization in cirrhotic patients with low ascitic fluid protein levels.
- A systematic review published in 2021 3 found that once weekly ciprofloxacin was not inferior to once daily norfloxacin for the prevention of SBP, with good tolerance and no induced resistance.
- A randomized, placebo-controlled study published in 2008 4 found that long-term administration of ciprofloxacin (500 mg/day for 12 months) reduced the risk of SBP and improved survival in cirrhotic patients with low protein concentration in ascitic fluid.
- However, a cohort study published in 2018 5 found that low ascitic fluid protein levels were not associated with the development of SBP, suggesting that other markers may be needed to predict SBP.
- A network meta-analysis published in 2019 6 found that ciprofloxacin, norfloxacin, and rifaximin were effective in preventing SBP, with rifaximin ranking first in terms of reducing the incidence of SBP and mortality.
Comparison with Other Antibiotics
- Ciprofloxacin has been compared to other antibiotics, such as norfloxacin, trimethoprim-sulfamethoxazole, and rifaximin, for the prevention of SBP.
- The systematic review published in 2021 3 found that norfloxacin and ciprofloxacin had similar efficacy for primary and secondary prophylaxis of SBP.
- The network meta-analysis published in 2019 6 found that rifaximin was the optimal regimen for protecting against SBP in patients with cirrhosis and ascites, although ciprofloxacin was also effective.