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Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice Angeloni S; Leboffe C; Parente A; Venditti M; Giordano A; Merli M; Riggio OWorld J Gastroenterol 2008[May]; 14 (17): 2757-62AIM: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. METHODS: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime. RESULTS: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 +/- 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. CONCLUSION: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.|*Practice Guidelines as Topic[MESH]|Aged[MESH]|Anti-Bacterial Agents/*therapeutic use[MESH]|Ascitic Fluid/microbiology/pathology[MESH]|Bacterial Infections/etiology/microbiology/pathology/*therapy[MESH]|Cefotaxime/*therapeutic use[MESH]|Drug Resistance, Bacterial[MESH]|Female[MESH]|Humans[MESH]|Liver Cirrhosis/*complications/therapy[MESH]|Male[MESH]|Middle Aged[MESH]|Neutrophils/pathology[MESH]|Peritonitis/etiology/microbiology/pathology/*therapy[MESH]|Treatment Failure[MESH]|Treatment Outcome[MESH] |
