Am J Gastroenterol

Is secondary SBP prophylaxis beneficial?

June 13, 2025

Study details: This retrospective cohort study identified patients with cirrhosis who survived an initial spontaneous bacterial peritonitis (SBP) episode, using data from the VA Corporate Data Warehouse and the TriNetX database (2009–2019). Researchers compared outcomes between patients who received secondary SBP prophylaxis (SecSBPPr), primarily fluoroquinolones, and those who didn't.

Results: In both cohorts (VA: n=4,673; TriNetX: n=6,708), approximately half of the patients received SecSBPPr. Multivariable analysis revealed a significantly higher risk of SBP recurrence in patients on SecSBPPr (hazards ratio [HR], 1.63–1.68; P < 0.001). Additionally, fluoroquinolone resistance was more common in the prophylaxis group (odds ratio [OR], 4.32; P = 0.03). These trends persisted at 6-month and 2-year follow-ups.

Clinical impact: Contrary to traditional practice, secondary SBP prophylaxis was associated with increased recurrence and antimicrobial resistance. These findings challenge current guidelines and suggest that routine use of SecSBPPr in cirrhosis patients should be re-evaluated in light of evolving bacterial resistance patterns.

Source:

Silvey S, et al. (2025, May). Am J Gastroenterol. Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts. https://pubmed.ncbi.nlm.nih.gov/39235290/