{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:42:40Z","timestamp":1784569360398,"version":"3.55.0"},"reference-count":112,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Spontaneous bacterial peritonitis (SBP) is the most common bacterial infection in cirrhotic patients. Historically, the bacterial spectrum was dominated by Gram-negative bacteria. However, recent studies showed that fluoroquinolone (FQ)-based prophylaxis promotes the intestinal overgrowth of Gram-positive bacteria and contributes to the selection of quinolone-resistant Gram-negative bacteria, increasing multidrug-resistant (MDR) organism infections. FQ resistance rates reach up to nearly one-third in community-acquired cases and 50% in hospital-acquired cases, raising concerns about FQ efficacy. Moreover, rare but serious side effects further limit FQ use. Predictive factors of FQ treatment failure have been identified, guiding management strategies. Rifaximin has emerged as a promising alternative for SBP prophylaxis, with encouraging results. This review aims to explore the shifting role of FQ-based SBP prophylaxis, focusing on the emerging concerns, side effects, and alternative strategies. While norfloxacin remains a first-line prophylactic in cirrhotic patients with low ascitic protein levels, its efficacy appears to be reduced in those with advanced liver failure or additional risk factors for MDR organisms. In these subgroups, alternative prophylactics, such as trimethoprim\u2013sulfamethoxazole or rifaximin, may be preferable. We propose a risk-stratification approach to guide treatment selection, with further studies needed to refine these criteria.<\/jats:p>","DOI":"10.3390\/life15040586","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:47:44Z","timestamp":1743580064000},"page":"586","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fluoroquinolones for the Prophylaxis of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis: Are They Losing Ground?"],"prefix":"10.3390","volume":"15","author":[{"given":"Simona","family":"Juncu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7736-8140","authenticated-orcid":false,"given":"Horia","family":"Minea","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Lungu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1694-3970","authenticated-orcid":false,"given":"Alina","family":"Jucan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Avram","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Buzuleac","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6395-335X","authenticated-orcid":false,"given":"Camelia","family":"Cojocariu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9882-9981","authenticated-orcid":false,"given":"Laura Sorina","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Internal Medicine and Gastroenterology, University Emergency Hospital, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. 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Popa\u201d University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.jhep.2020.11.019","article-title":"PREDICT STUDY group of the EASL-CLIF CONSORTIUM. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis","volume":"74","author":"Trebicka","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s11938-019-00229-2","article-title":"Infections in Cirrhosis","volume":"17","author":"Ekpanyapong","year":"2019","journal-title":"Curr. Treat. 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