Spontaneous bacterial peritonitis recurrence on norfloxacin secondary prophylaxis

Background and study aims: Secondary prophylaxis with norfloxacin reduces recurrence of spontaneous bacterial peritonitis (SBP) significantly. No data available from Asia-Pacific region about recurrence of SBP in these patients. Patients and methods: In a retrospective cohort study, we assessed recurrence rate of SBP in patients on norfloxacin secondary prophylaxis. One year recurrence of SBP, its profile, response rate and risk factors for recurrence were assessed. Results: A total of 112 patients were analysed. During first episode of SBP, culture positive rate was 39/112(34.8 %) and resistance to ceftriaxone was 51.2 %. Overall efficacy of ceftriaxone as first line antibiotic was 70.5 % (70/112), but only 49 % (19/39) among culture positive patients. E. coli is the commonest organism isolated (21/39, 53.8 %), MDR organism in 12.8 % (5/39). Cumulative incidence of SPB recurrence was 22.3 % (25/112) on norfloxacin secondary prophylaxis at 1 year. Culture positive rate in recurrent SBP was 48 % (12/25) and ceftriaxone resistance and MDR organism were seen in 66.6 % and 16.6 %. Overall response rate to ceftriaxone in recurrent SBP was 40 % (10/25) and 21 % (3/14) in culture positive patients. Risk factors for SBP recurrence were age, INR and albumin (p < 0.05). No increase cumulative incidence of death among patients with or without recurrence. Conclusion: Despite recent changes in bacteriological profile in SBP, recurrence of SBP on norfloxacin prophylaxis remains low. In recurrent SBP, response to ceftriaxone is significantly lower than first episode and there is trend towards increase in MDR organism in culture positive patient receiving norfloxacin.