Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study

Terg, Rubén; Cobas, Sergio; Fassio, E; Landeira, Graciela; Ríos, Beatriz; Vasen, Walter; Abecasis, Raquel; Ríos, Héctor; Guevara, Mónica

doi:10.1034/j.1600-0641.2000.033004564.x

Cited by 54 publications

(46 citation statements)

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“…Fortunately, these organisms retain their sensitivity to cefotaxime [62,63] , but this emphasizes the concept that patients who develop SBP on quinolone prophylaxis should not receive these drugs for treatment but instead undergo treatment with a third-generation cephalosporin (i.e. cefotaxime) [48,51,55] .…”

Section: Prophylaxismentioning

confidence: 99%

“…The treatment of patients with a potentially life-threatening infection using outpatient oral antibiotics is controversial, especially as 50% of patients with SBP have concomitant bacteremia, compliance cannot be assured, and serial examinations and repeat ascitic fl uid analysis are diffi cult [48] . Perhaps an initial course of inpatient intravenous antibiotics for several days followed by outpatient oral therapy once the stability of the patient is assured would be a reasonable option, but is one that still needs further evaluation in future prospective studies [48,55] . Patients suspected to have secondary bacterial peritonitis should additionally be placed on antibiotics with enterococcal and anaerobic coverage [5,44] and undergo laparotomy if a surgical source of infection is confi rmed on radiologic investigation [43] .…”

Section: Diagnosismentioning

confidence: 99%

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Spontaneous Bacterial Peritonitis

Sheer

Runyon

2005

Dig Dis

102

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Spontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid in patients with decompensated cirrhosis. The modifier ‘spontaneous’ distinguishes this from surgical peritonitis. The infecting organisms are usually enteric gram-negatives which have translocated from the bowel. Symptoms of infection occur in most patients with SBP, including fever, abdominal pain, mental status changes, and ileus. A high index of suspicion should exist for SBP in patients with cirrhosis and ascites. Diagnostic abdominal paracentesis can be undertaken with minimal risk and should be performed in all patients admitted to the hospital, during times of worsening clinical appearance, or when gastrointestinal bleeding occurs. The ascitic fluid polymorphonuclear cell count is the most sensitive test in evaluating for infection. Cultures of the ascitic fluid are helpful in identifying the organism and are best performed by bedside injection of blood culture bottles. Ascites total protein, lactate dehydrogenase, and glucose levels can assist in distinguishing SBP from secondary peritonitis. Empirical therapy is recommended after paracentesis if suspicion for infection exists. Cefotaxime is the best-studied antibiotic for this purpose and has excellent penetration into ascites with no nephrotoxicity. Prophylaxis should be limited to high-risk settings. Mortality rates in SBP have declined dramatically, largely due to earlier detection and improved therapy.

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Section: Prophylaxismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Spontaneous Bacterial Peritonitis

Sheer

Runyon

2005

Dig Dis

102

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“…This is a new finding, as immunosuppression has not been investigated as a predictive factor of mortality in previous SBP series. [31][32][33][34] The degree of liver function and renal failure are classical predictive factors of mortality. However, immunosuppression is not an unexpected predictive factor.…”

Section: Discussionmentioning

confidence: 99%

Role of immunosuppression in the development of quinolone‐resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis

Cereto¹,

Molina²,

González³

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: Norfloxacin decreases the incidence of spontaneous bacterial peritonitis in cirrhotics, but promotes the appearance of quinolone-resistant Escherichia coli. Aim: To define the characteristics of quinolone-resistant E. coli spontaneous bacterial peritonitis. Methods: E. coli-positive ascitic fluid cultures were identified during a 6-year period. Data on quinolonesensitive and quinolone-resistant E. coli spontaneous bacterial peritonitis were compared. Results: One hundred and two E. coli-positive ascitic fluid cultures were detected. Cirrhotics accounted for 67 cases. Spontaneous bacterial peritonitis was found in 47 of the 67 (70%) cases [35 (74%) caused by quinolonesensitive and 12 (26%) caused by quinolone-resistant E. coli]. Norfloxacin prophylaxis was higher in the

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“…Two recent studies confirmed the safety and efficacy of intravenously administered amoxicillin/clavulanic acid (3-4x1.2 g) in the treatment of SBP [82,83]. In uncomplicated SBP (absence of the followings: ileus, gastrointestinal bleeding, septic shock, HE with grade 2-4 or serum creatinin  3 mg/dL) oral, highly bioavailable quinolones (ofloxacin 2x400 mg, ciprofloxacin 2x500 mg) have been found as effective as the intravenous third-generation cephalosporins [84,85]. However, quinolons are not recommended in patients receiving norfloxacin prophylaxis or in geographic areas with a high prevalence of quinolone-resistant bacteria.…”

Section: Spontaneous Bacterial Peritonitis (Sbp)mentioning

confidence: 94%

Bacterial infections in cirrhosis

et al. 2007

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Patients with cirrhosis are highly susceptible for bacterial infections and their severe courses. Infections occur more often in advanced stage of liver disease, impair hepatic function, trigger the onset of complications, and are significant factors of mortality as well. Gastrointestinal hemorrhage confers a higher risk for infections and infections play important role in provoking of variceal bleeding episodes and can also be associated with the failure to control bleeding. In the past, the dominant pathogens were Gram-negative bacteria, but nowadays participation of Gram-positive strains has been increasing. Occurrence of opportunistic bacteria is far from rare. Spreading of resistant organisms and appearance of Clostridium difficile associated disease related with higher mortality are increasing problem due to the consequence of repeated antibiotic treatment of recurring infections, multiple hospitalizations and use of long-term antibiotic prophylaxis. In cirrhosis, immunodeficiency is multifactorial and progresses with the disease severity. Thus bacteria commonly get into the circulation from the infection ports causing frequent and prolonged bacteremia. Circulating bacteria colonize and proliferate in different organs inducing secondary focal infections. Intestinal tract considered a significant portal of entry. Translocation of the gut microflora mainly related to the development of spontaneous bacterial peritonitis. It is reasonable to assume that spontaneous bacteremia leads to other systemic infections but this is yet to be outlined adequately. Identification of infectious episodes are challenging due to the lack of typical signs and courses up to fifty percent of the cases. Early recognition and effective treatment of infections are essential in decreasing the high mortality.

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Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study

Cited by 54 publications

References 0 publications

Spontaneous Bacterial Peritonitis

Spontaneous Bacterial Peritonitis

Role of immunosuppression in the development of quinolone‐resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis

Bacterial infections in cirrhosis

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