Evidence map›Paper›PMID 26660707›Full record

Trial reportHepatology international2016

Efficacy and safety of alternating norfloxacin and rifaximin as primary prophylaxis for spontaneous bacterial peritonitis in cirrhotic ascites: a prospective randomized open-label comparative multicenter study.

M Assem, M Elsabaawy, M Abdelrashed, S Elemam, S Khodeer, W Hamed, A Abdelaziz, G El-Azab

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Hepatology international, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 4 pooled it
2.4field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 4 syntheses or guidelines pooled it, 57 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Guideline
  5. Review
  6. Disease Modulating Agents in Cirrhosis.Clinics in liver disease · 2026
    Review
  7. Article
  8. Review
  9. Article
  10. Review
  11. Review
  12. Article
  13. Review
  14. The Use of Rifaximin in Patients With Cirrhosis.Hepatology (Baltimore, Md.) · 2021
    Review
  15. Liver Cirrhosis and Sarcopenia from the Viewpoint of Dysbiosis.International journal of molecular sciences · 2020
    Review
  16. Article
  17. Article
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 2 countries.

M AssemHepatology Department, National Liver Institute, Menoufia University, Shebeen El Koom, Menoufia, 52311, Egypt. medassem68@yahoo.com.
M ElsabaawyHepatology Department, National Liver Institute, Menoufia University, Shebeen El Koom, Menoufia, 52311, Egypt.
M AbdelrashedInternal Medicine Department, Al Noor Hospital, M.O.H, Mecca, Saudi Arabia.
S ElemamTropical Medicine Department, King Khalid Hospital, M.O.H, Tabuk, Saudi Arabia.
S KhodeerInternal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
W HamedTropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
A AbdelazizClinical Pathology Department, National Liver Institute, Menoufia University, Shebeen El Koom, Menoufia, 52311, Egypt.
G El-AzabHepatology Department, National Liver Institute, Menoufia University, Shebeen El Koom, Menoufia, 52311, Egypt.
Menoufia University · EGAin Shams University · EGKing Khalid University · SASaad Specialist Hospital · SATanta University · EG

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimPrimary prevention of spontaneous bacterial peritonitis (SBP) is an important strategy to reduce morbidity and mortality in cirrhotic patients with ascites. Efficacy and safety of alternating rifaximin and norfloxacin as primary prophylaxis is questionable.

methodsThree hundred thirty-four cirrhotic patients with high SAAG (≥1.1) ascites, protein level in ascitic fluid less than 1.5 g/dL with advanced liver disease (Child-Pugh score >9 points with serum bilirubin level >3 mg/dL) or renal impairment (serum creatinine level >1.2 mg/dL, blood urea nitrogen level >25 mg/dL, or serum sodium level <130 mEq/L) were included in an open-label, randomized study aimed at comparing alternating use of norfloxacin and rifaximin vs. norfloxacin or rifaximin alone as primary prophylaxis for SBP. Both intention-to-treat and per-protocol efficacy analyses were done after 6 months of treatment by assessment of ascitic fluid neutrophil count. Safety analysis was done for all intention-to-treat populations.

resultsAlternating norfloxacin and rifaximin showed superior prophylaxis by intention-to-treat (74.7 vs. 56.4% vs. 68.3%, p < 0.048). Pairwise analysis showed that alternating regimen had lower probability to develop SBP when compared to a norfloxacin-based regimen in intention-to-treat (p = 0.016) and per protocol analysis (p = 0.039). There was no difference among the studied groups regarding the incidence and severity of adverse events reported.

conclusionsAlternating norfloxacin- and rifaximin-based primary prophylaxis for SBP showed higher efficacy with the same safety profile when compared with monotherapy of norfloxacin.

Indexed as

AdultAgedAntibiotic ProphylaxisBacterial InfectionsDrug Administration ScheduleFemaleHumansIncidenceLiver CirrhosisMaleMiddle AgedNorfloxacinPeritonitisProspective StudiesRifamycinsRifaximinNorfloxacinRifamycinsRifaximinNorfloxacinPrimary prophylaxisRifaximinSpontaneous bacterial peritonitis

Identifiers

PMID26660707
OpenAlexW2194122109

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.