Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: Results of a prospective, randomized, multicenter study

Abstract

Cefotaxime (CTX) is considered one of the first-choice antibiotics in the therapy of spontaneous bacterial peritonitis (SBP) in cirrhosis. Because CTX is largely metabolized in the liver, this drug may also be effective in SBP by administering lower doses than those habitually used. To investigate this possibility, a prospective, randomized, multicenter study was performed to compare the therapeutic efficacy of two different dosages of CTX in 143 patients with SBP: 71 (group I) were allocated to receive a high dose (2 g every 6 hours, which is one of the most frequently recommended doses in this infection), and 72 (group II) were allocated to receive a low dose (2 g every 12 hours). At inclusion, both groups were similar in relation to clinical and laboratory data, with the exception of a higher incidence of positive ascitic fluid culture in group I than in group II (59% vs. 40%; P = .029). The rate of infection resolution was similar for both groups (77% vs. 79%). Hospital survival was also similar in both groups (69% vs. 79%). No difference was observed between patients with positive or negative ascitic fluid cultures with regard to infection resolution and patient survival. The duration of antibiotic therapy was similar in both groups (9.0 +/- 3.3 days in group I vs. 8.8 +/- 3.1 days in group II). In a subset of 13 patients from group I and 11 patients from group II CTX levels were determined in serum (peak and trough) and ascitic fluid (concomitantly with trough serum). Peak serum levels were similar in patients from both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

“…The second is that quinolones may inhibit bacterial translocation by a mechanism different from a reduction in the concentration of GNB in the fecal flora. 32,46 In the current study 14 SBP caused by QR-GNB were detected. However, only 8 of them occurred in patients receiving long-term norfloxacin treatment.…”

“…First, the rate of culture-positive SBP was remarkably low (39%) despite the fact that ascitic fluid cultures were performed following standard methods. Although in the initial studies, almost 80% of SBP were culture-positive, 31 in our last studies on SBP, this proportion ranged between 50% and 59%, [32][33][34] probably reflecting an earlier diagnosis of the infection. The second important change in SBP was related to the type of organisms isolated in patients on long-term selective intestinal decontamination with norfloxacin.…”

Characterisation of bacteria in ascites—reporting the potential of culture-independent, molecular analysis

“…However, the development of a rapid, sensitive and accurate method to detect and characterise bacteria in ascites would provide an opportunity to make an appropriate intervention before an infection has been established. Further, where SBP does develop but antibiotic therapy is not effective, the mortality rate is very high, even when antibiotic treatment is appropriately modified [12,30,31]. Therefore, assessing the course of the infection is important to recognise treatment failure as early as possible.…”

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

“…A prática de se realizar paracentese rotineiramente, o alto índice de suspeita da infecção e a melhor clareza dos critérios diagnósticos resultaram na melhora do prognóstico desses pacientes. Por outro lado, acredita-se que outro fator decisivo no incremento das taxas de cura e na sobrevida nessa infecção, deva-se ao uso de antibióticos mais eficazes e seguros, sem a nefrotoxicidade das terapias anteriores (13,25,27,34) .…”