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This therapeutic regimen consists of the multi-strain probiotic preparation VSL#3 and the fluoroquinolone antibiotic norfloxacin, evaluated by the All India Institute of Medical Sciences (AIIMS) for the prevention of spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Norfloxacin is a broad-spectrum antibiotic that targets Gram-negative enteric bacteria by inhibiting DNA gyrase and topoisomerase IV, thereby preventing bacterial replication. VSL#3 is a high-potency probiotic containing 450 billion CFU of multiple bacterial strains, including Lactobacilli, Bifidobacteria, and Streptococcus thermophilus. It is intended to modulate the intestinal microbiota, enhance the mucosal barrier, and reduce bacterial translocation from the gut to the ascitic fluid. The regimen is studied as a strategy to prevent SBP while potentially mitigating the risks of antibiotic resistance associated with long-term quinolone prophylaxis.
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