for the main comparison.
| Antibiotic treatment for spontaneous bacterial peritonitis in people with decompensated liver cirrhosis | ||||||
|
Patient or population: people with cirrhosis and spontaneous bacterial peritonitis Settings: secondary or tertiary care Intervention: various interventions Comparison: ceftriaxone Follow‐up period: 1 week to 3 months Network geometry plots: Figure 1 | ||||||
| Interventions | Relative effect (95% CrI) | Anticipated absolute effect* (95% CrI) | Certainty of evidence | Ranking** | ||
| Ceftriaxone | Various interventions | Difference | ||||
| All‐cause mortality Total studies: 7 Total participants: 458 | ||||||
| Cefotaxime (1 RCT; 37 participants) | HR 0.56 (0.11 to 2.28) Network estimate | 263 per 1000 | 146 per 1000 (28 to 599) | 117 fewer per 1000 (235 fewer to 336 more) | Very lowa,b,c | ‐ |
| Ciprofloxacin (1 RCT; 35 participants) | HR 0.65 (0.12 to 2.72) Network estimate | 263 per 1000 | 171 per 1000 (31 to 717) | 92 fewer per 1000 (232 fewer to 454 more) | Very lowa,b,c | ‐ |
| Ceftazidime (No direct RCT) | HR 1.15 (0.17 to 6.37) Network estimate | 263 per 1000 | 301 per 1000 (45 to 1000) | 38 more per 1000 (218 fewer to 737 more) | Very lowa,b,c | ‐ |
| Amikacin (No direct RCT) | HR 0.76 (0.09 to 5.90) Network estimate | 263 per 1000 | 201 per 1000 (24 to 1000) | 62 fewer per 1000 (239 fewer to 737 more) | Very lowa,b,c | ‐ |
| Cefixime (1 RCT; 38 participants) | HR 1.26 (0.26 to 6.90) Network estimate | 263 per 1000 | 331 per 1000 (68 to 1000) | 68 more per 1000 (195 fewer to 737 more) | Very lowa,b,c | ‐ |
| Cefonicid (1 RCT; 60 participants) | HR 1.30 (0.52 to 3.24) Network estimate | 263 per 1000 | 341 per 1000 (138 to 853) | 78 more per 1000 (126 fewer to 590 more) | Very lowa,b,c | ‐ |
| Meropenem plus daptomycin (No direct RCT) | HR 0.64 (0.05 to 6.13) Network estimate | 263 per 1000 | 169 per 1000 (14 to 1000) | 94 fewer per 1000 (249 fewer to 737 more) | Very lowa,b,c | ‐ |
| Ofloxacin (No direct RCT) | HR 0.56 (0.09 to 2.93) Network estimate | 263 per 1000 | 147 per 1000 (23 to 770) | 116 fewer per 1000 (240 fewer to 507 more) | Very lowa,b,c | ‐ |
| Health‐related quality of life | ||||||
| None of the trials reported this outcome | ||||||
| Serious adverse events (proportion of participants) | ||||||
| None of the trials with ceftriaxone as control group reported this outcome | ||||||
| Serious adverse events (number of events per participant) | ||||||
| None of the trials reported this outcome | ||||||
| Adverse events (proportion of participants) Total studies: 5 Total participants: 297 | ||||||
| Cefotaxime (1 RCT; 37 participants) | OR 0.64 (0.15 to 2.62) Network estimate | 67 per 1000 | 44 per 1000 (10 to 157) | 23 fewer per 1000 (56 fewer to 91 more) | Very lowa,b,c | ‐ |
| Ciprofloxacin (1 RCT; 35 participants) | OR 1.02 (0.24 to 4.16) Network estimate | 67 per 1000 | 68 per 1000 (17 to 229) | 1 more per 1000 (50 fewer to 162 more) | Very lowa,b,c | ‐ |
| Ceftazidime (No direct RCT) | OR 1.97 (0.38 to 10.18) Network estimate | 67 per 1000 | 123 per 1000 (27 to 421) | 57 more per 1000 (40 fewer to 354 more) | Very lowa,b,c | ‐ |
| Amikacin (No direct RCT) | OR 0.69 (0.04 to 10.94) Network estimate | 67 per 1000 | 47 per 1000 (3 to 439) | 20 fewer per 1000 (64 fewer to 372 more) | Very lowa,b,c | ‐ |
| Cefonicid (1 RCT; 60 participants) | OR 1.00 (0.10 to 10.16) Network estimate | 67 per 1000 | 67 per 1000 (7 to 420) | 0 fewer per 1000 (60 fewer to 354 more) | Very lowa,b,c | ‐ |
| Meropenem plus daptomycin (No direct RCT) | OR 1.20 (0.10 to 13.53) Network estimate | 67 per 1000 | 79 per 1000 (7 to 491) | 12 more per 1000 (60 fewer to 425 more) | Very lowa,b,c | ‐ |
| Adverse events (number of events per participant) | ||||||
| None of the trials with ceftriaxone as control group reported this outcome | ||||||
| Liver transplantation | ||||||
| None of the trials with ceftriaxone as control group reported this outcome | ||||||
| Spontaneous bacterial peritonitis (symptomatic) | ||||||
| None of the trials reported this outcome | ||||||
| Spontaneous bacterial peritonitis (as per definition used for spontaneous bacterial peritonitis) Total studies: 7 Total participants: 638 | ||||||
| Cefotaxime (1 RCT; 37 participants) | HR 0.90 (0.42 to 1.86) Network estimate | 733 per 1000 | 661 per 1000 (308 to 1000) | 73 fewer per 1000 (425 fewer to 267 more) | Very lowa,b,c | ‐ |
| Ciprofloxacin (2 RCT; 275 participants) | HR 0.93 (0.69 to 1.25) Network estimate | 733 per 1000 | 679 per 1000 (504 to 916) | 54 fewer per 1000 (230 fewer to 183 more) | Very lowa,b,c | ‐ |
| Ceftazidime (No direct RCT) | HR 0.97 (0.55 to 1.72) Network estimate | 733 per 1000 | 713 per 1000 (403 to 1000) | 21 fewer per 1000 (330 fewer to 267 more) | Very lowa,b,c | ‐ |
| Amikacin (No direct RCT) | HR 0.54 (0.17 to 1.62) Network estimate | 733 per 1000 | 393 per 1000 (126 to 1000) | 340 fewer per 1000 (608 fewer to 267 more) | Very lowa,b,c | ‐ |
| Cefixime (1 RCT; 38 participants) | HR 0.78 (0.32 to 1.90) Network estimate | 733 per 1000 | 575 per 1000 (232 to 1000) | 159 fewer per 1000 (501 fewer to 267 more) | Very lowa,b,c | ‐ |
| Meropenem plus daptomycin (No direct RCT) | HR 1.29 (0.43 to 3.92) Network estimate | 733 per 1000 | 944 per 1000 (315 to 1000) | 211 more per 1000 (419 fewer to 267 more) | Very lowa,b,c | ‐ |
| Ofloxacin (No direct RCT) | HR 1.12 (0.45 to 2.70) Network estimate | 733 per 1000 | 825 per 1000 (330 to 1000) | 91 more per 1000 (404 fewer to 267 more) | Very lowa,b,c | ‐ |
| Other features of decompensation (per participant) Total studies: 5 Total participants: 360 | ||||||
| Cefotaxime (1 RCT; 37 participants) | Rate ratio 1.22 (0.43 to 3.53) Network estimate | 368 per 1000 | 449 per 1000 (160 to 1301) | 80 more per 1000 (209 fewer to 933 more) | Very lowa,b,c | ‐ |
| Ciprofloxacin (1 RCT; 35 participants) | Rate ratio 1.01 (0.32 to 3.16) Network estimate | 368 per 1000 | 373 per 1000 (119 to 1164) | 4 more per 1000 (249 fewer to 795 more) | Very lowa,b,c | ‐ |
| Ceftazidime (No direct RCT) | Rate ratio 1.43 (0.40 to 5.19) Network estimate | 368 per 1000 | 527 per 1000 (147 to 1911) | 159 more per 1000 (222 fewer to 1542 more) | Very lowa,b,c | ‐ |
| Amikacin (No direct RCT) | Rate ratio 1.28 (0.11 to 15.66) Network estimate | 368 per 1000 | 471 per 1000 (40 to 5769) | 103 more per 1000 (329 fewer to 5400 more) | Very lowa,b,c | ‐ |
| Meropenem plus daptomycin (No direct RCT) | Rate ratio 2.19 (0.49 to 9.49) Network estimate | 368 per 1000 | 807 per 1000 (179 to 3495) | 438 more per 1000 (189 fewer to 3127 more) | Very lowa,b,c | ‐ |
| Ofloxacin (No direct RCT) | Rate ratio 1.12 (0.31 to 4.09) Network estimate | 368 per 1000 | 412 per 1000 (113 to 1508) | 44 more per 1000 (255 fewer to 1139 more) | Very lowa,b,c | ‐ |
| *Anticipated absolute effect. Anticipated absolute effect compares two risks by calculating the difference between the risks of the intervention group with the weighted median risk of the control group. **Ranking is not provided as the median rank was not 1 for at least one of the ranking positions for each intervention for the outcome. CrI: credible interval; HR: hazard ratio; OR: odds ratio; RCT: randomised clinical trial | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aThe trial(s) included in the analysis was/were at high risk of bias (downgraded 1 level). bThe sample size was small (downgraded 1 level). cThe credible intervals were wide (includes clinical benefit and harms) (downgraded 1 level).