A Prospective Study On Rifaximin's Activity And Immunomodulatory Impact In Prophylaxis Of Spontaneous Bacterial Peritonitis In Cirrhotic Pakistani Population

Abstract

Aims: The purpose of this study was to assess rifaximin's effectiveness and immunomodulatory effects as another possible preventative treatment for cirrhotics' spontaneous bacterial peritonitis (SBP).

Methods: The design of this study was a prospective study design. This study was conducted at shaikh Zayed Hospital Lahore and the duration of this study was from July 2021 to May 2022. The research comprised 50 individuals with ascites and cirrhosis. In a randomised single-blind way, the patients were split into two groups. Rifaximin was given to group one (n=30), while norfloxacin was given to group two (n=20). The course of therapy lasted six months. The main inflammatory indicators employed in the study to assess the impact of the drugs used were serum levels of tumour necrosis factor alpha (TNF-), interleukin-6 (IL-6), and interleukin-10 (IL-10).

Results: Five patients receiving norfloxacin therapy demonstrated spontaneous bacterial peritonitis three months after treatment, however all cases receiving rifaxine therapy were spontaneous bacterial peritonitis -free. TNF-, IL-6, and IL-10 blood levels did not significantly differ between individuals receiving rifaximin and norfloxacin treatment (p>0.05). The blood levels of TNF- and IL-6 in patients receiving treatment with rifaximin and norfloxacin both decreased statistically significantly from baseline values (p=0.000 and p=0.000, respectively). In contrast, serum IL-10 increased in both groups compared to baseline (p>0.00) in a statistically significant manner. Those receiving rifaximin therapy had a more successful remission from spontaneous bacterial peritonitis six months after treatment than those receiving norfloxacin medication.

Conclusion: In the conclusion of this study, the usage of rifaximin in spontaneous bacterial peritonitis patients not only stops bacterial translocation but also regulates the immune system's production of pro- and anti-inflammatory cytokines. Rifaximin's effectiveness and immunomodulatory impact in the prevention of spontaneous bacterial peritonitis in cirrhotics, however, need more prospective large-scale, double-blind investigations.