Impact of Quinolone Prophylaxis on Spontaneous Bacterial Peritonitis and Mortality in Cirrhosis Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Ajay Malvi,
Nipun Verma,
Mahalaqua Nazli Khatib,
Subbulakshmi Ganesan,
Mandeep Kaur,
Manish Srivastava,
Amit Barwal,
G. V. Siva Prasad,
Pranchal Rajput,
Rukshar Syed,
Kamal Kundra,
Kratika Sharma,
Diptismitha Jena,
Frederick Sidney Correa,
Abhinav Rathour,
Ganesh Bushi,
Rachana Mehta,
Sanjit Sah,
Prakasini Satapathy,
Shilpa Gaidhane,
Muhammed Shabil,
Hashem Abu Serhan
Affiliations
Ajay Malvi
National Institute of Pharmaceutical Education and Research Guwahati India
Nipun Verma
Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
Mahalaqua Nazli Khatib
Division of Evidence Synthesis, Global Consortium of Public Health and Research Datta Meghe Institute of Higher Education Wardha India
Subbulakshmi Ganesan
Department of Chemistry and Biochemistry, School of Sciences JAIN (Deemed to Be University) Bangalore Karnataka India
Mandeep Kaur
Department of Allied Healthcare and Sciences Vivekananda Global University Jaipur India
Manish Srivastava
Department of Endocrinology NIMS University Jaipur India
Amit Barwal
Chandigarh Pharmacy College Chandigarh Group of College Mohali Punjab India
G. V. Siva Prasad
Department of Chemistry Raghu Engineering College Visakhapatnam Andhra Pradesh India
Pranchal Rajput
School of Applied and Life Sciences, Division of Research and Innovation Uttaranchal University Dehradun India
Rukshar Syed
IES Institute of Pharmacy IES University Bhopal Madhya Pradesh India
Kamal Kundra
New Delhi Institute of Management New Delhi India
Kratika Sharma
Department of Emergency, Graphic Era Institute of Medical Sciences Graphic Era (Deemed to Be University) Clement Town Dehradun India
Diptismitha Jena
Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences Saveetha University Chennai India
Frederick Sidney Correa
Centre of Research Impact and Outcome Chitkara University Rajpura Punjab India
Abhinav Rathour
Chitkara Centre for Research and Development Chitkara University Chitkara Himachal Pradesh India
Ganesh Bushi
School of Pharmaceutical Sciences Lovely Professional University Phagwara India
Rachana Mehta
Clinical Microbiology, RDC Manav Rachna International Institute of Research and Studies Faridabad Haryana India
Sanjit Sah
SR Sanjeevani Hospital, Kalyanpur Siraha Nepal
Prakasini Satapathy
University Center for Research and Development Chandigarh University Mohali Punjab India
Shilpa Gaidhane
One Health Centre (COHERD), Jawaharlal Nehru Medical College Datta Meghe Institute of Higher Education Wardha India
Muhammed Shabil
Noida Institute of Engineering and Technology (Pharmacy Institute) Greater Noida India
Hashem Abu Serhan
Department of Ophthalmology, Hamad Medical Corporation Doha Qatar
ABSTRACT Background Cirrhosis is a major global health concern due to its progressive nature and high risk of complications, including spontaneous bacterial peritonitis (SBP), which significantly increases mortality. Quinolone antibiotics, especially norfloxacin, are commonly used for SBP prophylaxis in high‐risk cirrhotic patients, but the long‐term impact on overall mortality remains uncertain. The purpose of this meta‐analysis and systematic review is to evaluate how quinolone prophylaxis affects the SBP incidence, mortality, and non‐SBP infections in cirrhosis patients. Methods A comprehensive search of Web of Science, Embase, and PubMed identified research evaluating quinolone prophylaxis on the risk of spontaneous bacterial peritonitis (SBP) and mortality in cirrhotic patients. Inclusion criteria included randomized controlled trials reporting risk ratios for patients on quinolone prophylaxis versus controls. A random‐effects meta‐analysis pooled the results, with heterogeneity assessed by the I2 statistic. Sensitivity analyses were performed for robustness. Results The search screened 1754 items and identified 6 relevant studies. Quinolone prophylaxis was associated with a significantly lower risk of spontaneous bacterial peritonitis (SBP), non‐SBP infections, and mortality in cirrhotic patients, with a pooled relative risk (RR) for SBP of 0.47 (95% CI: 0.22–1.01), for non‐SBP infections of 0.79 (95% CI: 0.66–0.94), and for mortality of 0.67 (95% CI: 0.52–0.86). Sensitivity analysis confirmed the robustness of these findings. Conclusion This meta‐analysis reveals that quinolone prophylaxis significantly lowers the risk of spontaneous bacterial peritonitis (SBP), other infections, and mortality in high‐risk cirrhotic patients. The results support incorporating quinolone prophylaxis in cirrhosis management to improve outcomes, with future studies needed to refine treatment duration and patient‐specific strategies.
