Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis

Runyon, Bruce A.; McHutchison, John G.; Antillon, Mainor R.; Akriviadis, Evangelos; Montano, Agnes A.

doi:10.1016/0016-5085(91)90677-d

Cited by 261 publications

(153 citation statements)

References 14 publications

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“…Infection was considered resolved when all signs of infection had disappeared, polymorphonuclear cell count in ascitic fluid had decreased to a level less than 250 cells/mm 3 , and ascitic fluid cultures were negative. 19 Antibiotic therapy was maintained for 48 hours after resolution of infection. Laboratory measurements and hemodynamic investigations were then repeated.…”

Section: Methodsmentioning

confidence: 99%

Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

et al. 2003

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Spontaneous bacterial peritonitis (SBP) is frequently associated with renal failure. This study assessed if systemic and hepatic hemodynamics are also affected by this condition. Standard laboratory tests, tumor necrosis factor ␣ (TNF-␣) in plasma and ascitic fluid, plasma renin activity (PRA) and norepinephrine (NE), and systemic and hepatic hemodynamics were determined in 23 patients with SBP at diagnosis and after resolution of infection. Eight patients developed renal failure during treatment. At diagnosis of infection, patients developing renal failure showed significantly higher values of TNF-␣, blood urea nitrogen (BUN), PRA and NE, peripheral vascular resistance, and hepatic venous pressure gradient (HVPG) and lower cardiac output than patients not developing renal failure. During treatment, a significant reduction in cardiac output and arterial pressure and increase in PRA and NE, HVPG, and Child-Pugh score were observed in the first group but not in the second. Peripheral vascular resistance remained unmodified in both groups. Changes in PRA and NE correlated inversely with changes in arterial pressure and directly with changes in BUN, Child-Pugh score, and HVPG. Five patients in the renal failure group developed encephalopathy, and 6 died. In the group without renal failure, none of the patients developed encephalopathy or expired. In conclusion, patients with SBP frequently develop a rapidly progressive impairment in systemic hemodynamics, leading to severe renal and hepatic failure, aggravation of portal hypertension, encephalopathy, and death. This occurs despite rapid resolution of infection and is associated with an extremely poor prognosis.

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Section: Methodsmentioning

confidence: 99%

Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

et al. 2003

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“…Antibiogram was performed with the disk diffusion method (Kirby-Bauer method) for ciprofloxacin (5), cefotaxime (30), ceftriaxone (30), gentamicin (10) and cotrimoxazole (1.25-23.15) (MAST Co. UK). Intravenous ceftriaxone (100 mg per kilogram body weight) was started empirically for all patients after paracentesis, as recommended in adult series [8,9] . After 48 h of antibiotic therapy ascites were resolved in 4 patients.…”

Section: Methodsmentioning

confidence: 99%

Organisms causing spontaneous bacterial peritonitis in children with liver disease and ascites in Southern Iran

Haghighat

Dehghani

Alborzi³

et al. 2006

WJG

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INTRODUCTIONSpontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without a demonstrable intraabdominal cause [1] . It is a well known complication of cirrhosis in adults, occurring in 8% to 13% of patients [2][3][4][5] . The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 2.5 × 10 5 /L). In adults, the organisms of SBP are usually gramnegative bacteria [2][3][4]6] , but they may differ in children [5,7] . The aim of the present study was to deter mine the causative agents of SBP in children with liver disease and ascites in our center. MATERIALS AND METHODSDuring a period of 2.5 years, from September 2003 to March 2006, 63 children with liver disease and ascites were prospectively studied in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated with Shiraz University of Medical Sciences, the major referral center in Southern Iran. Written consent was obtained from all parents after informing them about this study which was approved by the Ethics Committee of the University.Of the children involved in this study 12 had met the criteria for SBP (polymorphonuclear leukocyte count greater than 2.5 × 10 5 /L and positive ascitic fluid culture). In total 13 episodes of SBP were documented, of which two occurred with one patient, 4 mo apart. The patients and their parents answered a structured questionnaire, which included name, age, sex, clinical history, underlying liver diseases, history of antibiotic and diuretic use, history of previous variceal bleeding and episodes of SBP. All children had undergone a thorough physical examination.Serum albumin and glucose, urinalysis and urine culture were done in all patients. CONCLUSION: S. pneumoniae is the most common cause of SBP in the pediatric age group and we recommend a third generation cephalosporine (e.g., Ceftriaxione or Cefotaxime) for empirical therapy in children with SBP.

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“…In a randomized controlled trial involving 100 patients, it has been reported that 5 days of treatment is as efficacious as 10 days in the treatment of carefully characterized patients with SBP. 66 Distinction From Secondary Bacterial Peritonitis. Secondary bacterial peritonitis, i.e., ascitic fluid infection caused by a surgically-treatable intra-abdominal source, can masquerade as SBP.…”

Section: Introductionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis

Runyon¹

1998

Hepatology

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302

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis

Cited by 261 publications

References 14 publications

Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis

Organisms causing spontaneous bacterial peritonitis in children with liver disease and ascites in Southern Iran

Management of adult patients with ascites caused by cirrhosis

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