New findings about an 'old' drag: Immunomodulatory effects of norfloxacin in cirrhosis

摘要

An interesting study by Gomez-Hurtado et al. in this month's issue of the Journal of Hepatology highlights new effects of norfloxacin on gut-associated lymphatic tissue (GALT) and trans-location of bacterial products in murine models of cirrhosis [1]. Norfloxacin, launched in 1980, was the first commercially available fluoroquinolone. The beneficial role of norfloxacin in cirrhosis has been clearly demonstrated in several studies. Oral norfloxacin administration (400mg/day) improves the circulatory derangement observed in cirrhotic patients, which is characterized by high cardiac output and low systemic vascular resistance [2,3]. Norfloxacin decreases the recurrence of spontaneous bacterial peritonitis (SBP) from ~70% to 20% after a first episode (secondary prophylaxis) [4]. Norfloxacin in patients with low protein ascitic levels (<1.5g/dl) and advanced cirrhosis (Child-Pugh score ≥9 points with serum bilirubin level ≥3 mg/dl or impaired renal function (serum creatinine level ≥1.2 mg/dl, blood urea nitrogen level ≥25 mg/dl, or serum sodium level ≤130 mEq/L)) without prior SBP episode reduces the probability of SBP (primary prophylaxis) and hepatorenal syndrome (HRS) and improves 3-month survival [5].