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Background Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid in the absence of other intra-abdominal sources. The risk is high in those with concomitant gastrointestinal bleeding, low ascitic fluid protein, or a previous attack of SBP. Norfloxacin is used widely in the primary prophylaxis of SBP but resistance usually develops where rifaximin was introduced. Patients and methods A total of 80 patients with advanced liver cirrhosis attending the Hemostasis Unit, Emergency Hospital, Mansoura University, with upper gastrointestinal bleeding were subjected to full history, clinical examination, laboratory assessment, and ascitic fluid analysis. The patients were divided into two groups: the first group received rifaximin plus norfloxacin and the second group received norfloxacin only and the two groups were followed up for 1 year. Results The study enrolled 80 patients, 51 men and 29 women with a mean age of 58.83±5.02 years for group 1 and 58.35±4.95 years for group 2. There were no statistically significant difference between the two groups as regards the clinical or laboratory characteristics except for the presence of focal lesions that was significantly present in group 2. A significant increase in the incidence of SBP in group 2 was present with P=0.014. The median time of developing SBP was significantly shorter in the second group. Conclusion The addition of rifaximin to norfloxacin decreased the incidence rates of SBP in patients with variceal bleeding with significant improvement in patient survival.

Rifaximin plus norfloxacin versus norfloxacin alone in primary prophylaxis of spontaneous bacterial peritonitis in patients with variceal bleeding