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Treatment of Spontaneous Bacterial Peritonitis

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Clinical Investigation of Portal Hypertension

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Abstract

After the diagnosis of spontaneous bacterial peritonitis (SBP), patients should immediately receive empiric antibiotic treatment. Until the results of susceptibility testing are available, broad-spectrum therapy is warranted in patients with a suspected ascitic fluid infection. A reasonable choice for suspected SBP is a third-generation cephalosporin, preferably cefotaxime 2 g every 8 h. In uncomplicated SBP, oral ofloxacin (400 mg twice per day for an average of 8 days) also provides similar results as intravenous cefotaxime. Intravenous albumin infusions can also decrease the risk of renal impairment that often develops in patients with SBP. Several randomized controlled trials have reported that the administration of antibiotic prophylaxis in high-risk SBP patients can decrease the risk of bacterial infection and mortality. However, in order to minimize bacterial resistance, it is necessary to restrict the use of these prophylactic antibiotics to patients who demonstrate the well-defined criteria for SBP prophylaxis.

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References

  1. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. Int Ascites Club J Hepatol. 2000;32:142–53.

    CAS  Google Scholar 

  2. Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Dis Mon. 1985;31:1–48.

    Article  CAS  Google Scholar 

  3. Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomerie JZ. Spontaneous bacterial peritonitis. Hepatology. 1982;2:399–407.

    Article  CAS  Google Scholar 

  4. Such J, Runyon BA. Spontaneous bacterial peritonitis. Clin Infect Dis. 1998;27:669–74. quiz 675-666

    Article  CAS  Google Scholar 

  5. Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L. Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database Syst Rev. 2009:CD002232.

    Google Scholar 

  6. Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Gines P, et al. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology. 1985;5:457–62.

    Article  CAS  Google Scholar 

  7. Runyon BA, Akriviadis EA, Sattler FR, Cohen J. Ascitic fluid and serum cefotaxime and desacetyl cefotaxime levels in patients treated for bacterial peritonitis. Dig Dis Sci. 1991;36:1782–6.

    Article  CAS  Google Scholar 

  8. Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49:2087–107.

    Article  Google Scholar 

  9. Rimola A, Salmeron JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology. 1995;21:674–9.

    Article  CAS  Google Scholar 

  10. Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology. 1991;100:1737–42.

    Article  CAS  Google Scholar 

  11. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397–417.

    Google Scholar 

  12. Ricart E, Soriano G, Novella MT, Ortiz J, Sabat M, Kolle L, et al. Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. J Hepatol. 2000;32:596–602.

    Article  CAS  Google Scholar 

  13. Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology. 1996;111:1011–7.

    Article  CAS  Google Scholar 

  14. Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60:1310–24.

    Article  Google Scholar 

  15. Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20:1495–501.

    Article  CAS  Google Scholar 

  16. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–9.

    Article  CAS  Google Scholar 

  17. Sigal SH, Stanca CM, Fernandez J, Arroyo V, Navasa M. Restricted use of albumin for spontaneous bacterial peritonitis. Gut. 2007;56:597–9.

    Article  Google Scholar 

  18. Fernandez J, Monteagudo J, Bargallo X, Jimenez W, Bosch J, Arroyo V, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology. 2005;42:627–34.

    Article  CAS  Google Scholar 

  19. Setoyama H, Tanaka M, Nagumo K, Naoe H, Watanabe T, Yoshimaru Y, et al. Oral branched-chain amino acid granules improve structure and function of human serum albumin in cirrhotic patients. J Gastroenterol. 2017;52(6):754–65.

    Article  CAS  Google Scholar 

  20. Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology. 1986;91:1343–6.

    Article  CAS  Google Scholar 

  21. Bleichner G, Boulanger R, Squara P, Sollet JP, Parent A. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. Br J Surg. 1986;73:724–6.

    Article  CAS  Google Scholar 

  22. Bernard B, Cadranel JF, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology. 1995;108:1828–34.

    Article  CAS  Google Scholar 

  23. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 2001;120:726–48.

    Article  CAS  Google Scholar 

  24. Soriano G, Guarner C, Teixido M, Such J, Barrios J, Enriquez J, et al. Selective intestinal decontamination prevents spontaneous bacterial peritonitis. Gastroenterology. 1991;100:477–81.

    Article  CAS  Google Scholar 

  25. Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990;12:716–24.

    Article  CAS  Google Scholar 

  26. Soriano G, Guarner C, Tomas A, Villanueva C, Torras X, Gonzalez D, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology. 1992;103:1267–72.

    Article  CAS  Google Scholar 

  27. Blaise M, Pateron D, Trinchet JC, Levacher S, Beaugrand M, Pourriat JL. Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology. 1994;20:34–8.

    Article  CAS  Google Scholar 

  28. Fernandez J, Ruiz del Arbol L, Gomez C, Durandez R, Serradilla R, Guarner C, et al. Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology. 2006;131:1049–56; quiz 1285.

    Article  CAS  Google Scholar 

  29. Singh N, Gayowski T, Yu VL, Wagener MM. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial. Ann Intern Med. 1995;122:595–8.

    Article  CAS  Google Scholar 

  30. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–3.

    Article  Google Scholar 

  31. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Dig Dis. 2016;34:382–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan

    Hiroko Setoyama, Motohiko Tanaka & Yutaka Sasaki

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  1. Hiroko Setoyama
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  2. Motohiko Tanaka
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  3. Yutaka Sasaki
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Correspondence to Yutaka Sasaki .

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Editors and Affiliations

  1. Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan

    Katsutoshi Obara

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Setoyama, H., Tanaka, M., Sasaki, Y. (2019). Treatment of Spontaneous Bacterial Peritonitis. In: Obara, K. (eds) Clinical Investigation of Portal Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-10-7425-7_53

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  • DOI: https://doi.org/10.1007/978-981-10-7425-7_53

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