Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

World J Gastroenterol. 2008 May 7;14(17):2757-62. doi: 10.3748/wjg.14.2757.


Aim: 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.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Ascitic Fluid / microbiology
  • Ascitic Fluid / pathology
  • Bacterial Infections / etiology
  • Bacterial Infections / microbiology
  • Bacterial Infections / pathology
  • Bacterial Infections / therapy*
  • Cefotaxime / therapeutic use*
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / therapy
  • Male
  • Middle Aged
  • Neutrophils / pathology
  • Peritonitis / etiology
  • Peritonitis / microbiology
  • Peritonitis / pathology
  • Peritonitis / therapy*
  • Practice Guidelines as Topic*
  • Treatment Failure
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Cefotaxime