Rifaximin Prophylaxis for Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome in Cirrhotic Patients

Norfloxacin is the most commonly used drug for the prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Rifaximin, another broad spectrum antibiotic with only trivial absorption from the gut, is used for the treatment of traveler's diarrhea and prevention of hepatic encephalopathy.

Inclusion Criteria:Decompensated cirrhotic patients (Child B or C, ascetic patients).Adult male/female aged >18 years old.History or evidence of previous attack of SBP and currently clinically free from SBP.Exclusion Criteria:Recent abdominal surgery.Patients with renal impairment (serum creatinine >1.5mg/dl) at baseline.Patients on renal replacement therapy (RRT) at baseline.Sonographic evidence of Nephropathy other than grade I nephropathy in ascetic patientsintraabdominal source of infection (e.g. intra-abdominal abscesses, cholecystitis or acute pancreatitis).Patients with current evidence of upper Urinary tract infection.Other comorbidities affecting the patient survival e.g. significant cardiac disease, pulmonary disease, portal vein thrombosis, hepatocellular carcinoma or other malignancies, etc.Sepsis.Current or recent treatment with nephrotoxic drugs or contrast material injection.