Norfloxacin beneficial only in select cases of advanced cirrhosis

Norfloxacin therapy in patients with advanced cirrhosis without recent fluoroquinolone therapy did not reduce 6-month mortality. The therapy, however, increased the survival of patients with low ascites fluid protein concentrations.

These are the results of a new study published in the journal Gastroenterology.

There is a debate over the effects of long-term oral fluoroquinolone therapy in patients with advanced cirrhosis. Richard Moreau, Assistance Publique – Hôpitaux de Paris, and colleagues performed a randomized controlled trial to evaluate the effects of long-term treatment with the fluoroquinolone norfloxacin on the survival of patients with cirrhosis.

The research team performed a double-blind trial of 291 patients with Child-Pugh class C cirrhosis who had not received recent fluoroquinolone therapy; the study was performed at 18 clinical sites in France from April 2010 through November 2014. Patients were randomly assigned to groups given 400 mg norfloxacin (n=144) or placebo (n=147), once-daily for 6 months. Patients were evaluated monthly for the first 6 months and at 9 months and 12 months thereafter. The primary outcome was 6-month mortality, estimated by the Kaplan-Meier method, censoring spontaneous bacterial peritonitis, liver transplantation, or loss during follow up.

Key Results:

• The Kaplan-Meier estimate for 6-month mortality was 14.8%for patients receiving norfloxacin and 19.7% for patients receiving placebo.


• In competing risk analysis that took liver transplantation into account, the cumulative incidence of death at 6 months was significantly lower in the norfloxacin group than in the placebo group (sub-distribution hazard ratio [SHR], 0.59; 95% CI, 0.35-0.99).


• The SHR for death at 6 months with norfloxacin vs placebo was 0.35 (95% CI, 0.13-0.93) in patients with ascites fluid protein concentrations of less than 15 g/L and 1.39 (95% CI, 0.42-4.57) in patients with ascites fluid protein concentrations of 15 g/L or more.


• Norfloxacin significantly decreased the incidence of any and Gram-negative bacterial infections without increasing infections caused by Clostridium difficile or multiresistant bacteria.

“Although these results should be interpreted with caution, in particular, because of missing data regarding ascitic fluid protein levels in some patients, they strongly suggest, along with previous findings obtained in an independent study, that patients with advanced cirrhosis and low ascitic fluid protein levels are good candidates for prolonged norfloxacin administration to decrease mortality,” the researchers concluded.

For further reference follow the link: https://doi.org/10.1053/j.gastro.2018.08.026