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For high-risk patients with cirrhosis and ascites, guidelines recommend antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) and its associated complications. However, tension exists between potential benefits of liberal prophylaxis and associated excess risk for antimicrobial resistance. In a meta-analysis of 23 randomized controlled trials that involved >2500 high-risk cirrhotic patients with ascites, individual antibiotic strategies for primary and secondary prevention of SBP were compared. Studies in which patients received prophylactic antibiotics for upper gastrointestinal bleeding were excluded.
No antibiotic — including norfloxacin, ciprofloxacin, trimethoprim-sulfamethoxazole, and rifaximin — individually yielde…