Primary norfloxacin prophylaxis prevents infections in liver failure patients, study finds

Hyderabad: In a new study it was found that in individuals with acute-on-chronic liver failure (ACLF), primary norfloxacin prophylaxis effectively avoids bacterial infections. In hospitalized cirrhotic patients with low ascitic fluid protein concentrations, norfloxacin can help avoid infections. It also works to keep spontaneous bacterial peritonitis from recurring. The findings of this study were published in The American Journal of Gastroenterology on January 17th, 2022.

Anand V. Kulkarni and colleagues conducted this study to assess the role of prophylactic norfloxacin in preventing bacterial infections and its impact on transplant-free survival (TFS) in patients with acute-on-chronic liver failure who met the Asian Pacific Association for the Study of the Liver criteria.

In this trial, patients with ACLF were given either oral norfloxacin 400 mg or a matching placebo once daily for 30 days. The primary objective was the occurrence of bacterial infections at days 30 and 90, whereas the secondary endpoint was TFS at days 30 and 90.

The results of this study stated as follow:

1. There were a total of 143 patients in the study (72 in the norfloxacin and 71 in the placebo groups).

2. The two groups had similar baseline demographics, biochemical characteristics, and severity levels.

3. In the norfloxacin and placebo groups, respectively, the incidence of bacterial infections at day 30 was 18.1% and 33.8%, while the incidence of bacterial infections at day 90 was 46% and 62%.

4. TFS at day 30 was 77.8% in the norfloxacin group and 64.8% in the placebo group, according to Kaplan-Meier analysis. TFS was 58.3% and 43.7% at day 90, respectively.

5. Multidrug-resistant organisms were responsible for 33% of illnesses.

6. The norfloxacin group had a higher rate of concurrent candiduria (25%) than the placebo group (2.63% ).

In conclusion, the findings of this study show the efficiency of norfloxacin in bacterial contamination and should be encouraged to be used as a frequent way of treatment.

Reference:

Kulkarni AV, Tirumalle S, Premkumar M, Kumar K, Fatima S, Rapole B, Simhadri V, Gora BA, Sasikala M, Gujjarlapudi D, Yelamanchili S, Sharma M, Gupta R, Rao PN, Reddy DN. Primary Norfloxacin Prophylaxis for APASL-Defined Acute-on-Chronic Liver Failure: A Placebo-Controlled Double-Blind Randomized Trial. Am J Gastroenterol. 2022 Jan 17. doi:10.14309/ajg.0000000000001611. Epub ahead of print. PMID: 35041634.