A Phase 2/3 interventional study of Probiotics and Placebo and Probiotics and Norfloxacin in Spontaneous Bacterial Peritonitis and Liver Cirrhosis, sponsored by All India Institute of Medical Sciences, New Delhi. Status unknown at 1 site in India. Open to participants aged 13 Years to 65 Years. Per ClinicalTrials.gov, last updated 2008-05-15.
Sponsored by All India Institute of Medical Sciences, New Delhi · Phase 2/3, Interventional, and Prevention
Cirrhotic patients are predisposed to bacterial infection. A large proportion of which is spontaneous bacterial peritonitis(SBP), which are mainly caused by enteric bacteria.SBP in a cirrhotic patients is associated with a high mortality rate in the order of 30-80% per year.It has been demonstrated that cirrhotics who have an ascitic fluid protein concentration less than 1gm% are most susceptible to develop SBP by virtue of having low opsonising activity of ascitic fluid.Patients with liver cirrhosis have significant degrees of imbalance of intestinal flora.Translocation of intestinal bacteria being the major mechanism for the production of SBP.
Long-term antibiotic (norfloxacin) is very effective in preventing SBP caused by gram negative bacteria.But the problem with the long-term antibiotic prophylaxis is the potential for the development of infection with antibiotic-resistant bacteria.Further, quinolones have no effect on gram positive bacteria which is becoming one of the important cause of SBP.
Such experiences necessitate the need for strategies, other than antibiotic, to prevent intestinal bacterial overgrowth, bacterial translocation and SBP in patients with cirrhosis.Probiotics have been used successfully to alter the gut flora in many clinical conditions where growth and localization of non pathogenic bacteria replaces the pathogenic bacteria in the intestine.The probiotic bacteria, among which the most common are the lactose fermenting Lactobacilli, inhibit the growth of pathogenic bacteria by acidifying the gut lumen, competing for nutrients, and by producing antimicrobial substances. They adhere to the gut mucosa and by that are thought to prevent bacterial translocation from the gut.
The purpose of this study is to determine the effectiveness of probiotics in the prevention of spontaneous bacterial peritonitis in patients with cirrhosis with low protein ascites and those already have developed an episode SBP.
AIMS :
To study the effect of a Probiotics administration in reducing the incidence of first episode of SBP among cirrhotics who have low protein(\<1 gm/dl) ascites.
To study the effect of a Probiotics administration in reducing the incidence of second episode of SBP among cirrhotic who have already developed at least one episode of SBP.
Study design : Prospective randomized placebo control efficacy study.
Inclusion criteria: All patients with liver cirrhosis with ascites having either history of prior SBP or ascitic fluid protein \<1 gm/dl will be included in the study irrespective of etiology.
Exclusion criteria :
Patients in primary prophylaxis group will be randomly allocated to receive either a Probiotics or placebo. While patients in secondary prophylaxis group will be randomized between Probiotics and norfloxacin.
The Probiotics used in this study will be VSL#3. The control will be given similar looking capsules containing galactose powder.It will be used in the form of capsules. A total dose of 450 billions CFU will be used. Norfloxacin will also be used as similar looking capsules. The drugs and placebo will be given for one year or till the end points of the study as mentioned below.
Monitoring Each patients will be tested for SBP( Ascitic fluid cell count as well as culture) at the interval of every 6 weeks till the end point of the study.The effect of Probiotics on gut flora will be assessed objectively by jejunal fluid culture analysis baseline at 6 months and 1 year of the start of the treatment. This will be done on some of the representative sample from both the groups. Development of an episode of SBP, hepatic encephalopathy and variceal bleeding will be noted.All patients will be prospectively followed up from the date of enrollment to see the primary outcome that is development of SBP. The secondary outcome of the study will be the development of encephalopathy, variceal bleeding ,renal failure and death of the patients.
End Points :
185 studies on the registry are indexed under Peritonitis; 25 are open to participants now.
This study's planned enrollment of 250 is above the median of 95 across 118 interventional studies indexed under Peritonitis.
Browse Peritonitis studies →All India Institute of Medical Sciences, New Delhi is the lead sponsor of 146 studies on the registry; 16 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Patients with liver cirrhosis with ascites having ascitic fluid protein \<1 gm/dl will be included in this arm. They will be randomized between probiotics and placebo.
Drug: Probiotics and Placebo
Patients with liver cirrhosis with ascites having history of prior SBP will be included in this arm. They will be randomized between probiotics and norfloxacin.
Drug: Probiotics and Norfloxacin
The Probiotics used in this study will be VSL#3. The control will be given similar looking capsules containing galactose powder. It will be used in the form of capsules. A total dose of 450 billions CFU will be used. Norfloxacin, 400 mg /day, will also be used as similar looking capsules. The drugs and placebo will be given for one year or till the end points of the study.
The Probiotics used in this study will be VSL#3. The control will be given similar looking capsules containing galactose powder.It will be used in the form of capsules. A total dose of 450 billions CFU will be used. Norfloxacin, 400 mg /day, will also be used as similar looking capsules. The drugs will be given for one year or till the end points of the study.
Development of an episode of SBP, completion of one year, or death
Time frame: till end points
development of encephalopathy, variceal bleeding and renal failure
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All India Institute of Medical Sciences, New Delhi