Spontaneous bacterial peritonitis treatment

Rimola A, Garcia-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis a consensus document. J Hepatol 2000 32 142-145. 

Mowat C, Stanley AJ Spontaneous bacterial peritonitis - Diagnosis, treatment and prevention. Aliment Pharmacol Ther 2001 15 1851-1859. 

Fernandez J, Bauer TM, Navasa M, Rodes J Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. Baillieres Best Pract Res Clin Gastroenterol 2000 14 975-990. 

Soares-Weiser K, Paul M, Brezis M, Leibovici M Antibiotic treatment for spontaneous bacterial peritonitis. BMJ 2002 324 100-102. 

Arroyo, V., Navasa, M., Rimola, A. Spontaneous bacterial peritonitis in liver cirrhosis. Treatment and prophylaxis. Infection 1994 22 (Suppl. 31) 167-175... 

Dlnis-Rlbeiro, M., Cortez-Pinto, H., Marlnho, R., Valente, A., Ral-mundo, M., Salgado, M.J., Ramalho, F., Alexandrlno, P., Carnelro-de-Moura, M. Spontaneous bacterial peritonitis in patients with hepatic cirrhosis evaluation of a treatment protocol at specialized units. Rev. Espan. Enferm. Dig. 2002 94 478-481... 

Ascites unresponsive to treatment Hepatopulmonary syndrome Hepatorenal syndrome Recurrent varix bleeding Severe hypoalimentation Spontaneous bacterial peritonitis... 

Trimethoprim is fairly active against a variety of Grampositive cocci and Gram-negative rods. Established indications for co-trimoxazole are infections of the sinuses, ears, lungs, and urinary tract, and infections due to Salmonella, Nocardia, Brucella, Stenotrophomonas maltophilia, Pneumocystis proved, and Toxoplasma (1,6). Co-trimoxazole is also used in the treatment of Wegener s granulomatosis, for prevention of spontaneous bacterial peritonitis, and in patients with advanced HIV infection for the prophylaxis of opportunistic infections (1,6). 

The following treatment guidelines for the management of adult patients with ascites and spontaneous bacterial peritonitis were developed and approved by the Practice Guidelines Committee of the American Association for the Study of Liver Diseases (AASLD). ... 

TREATMENT RECOMMENDATIONS ASCITES AND SPONTANEOUS BACTERIAL PERITONITIS... 

Guamer C, Runyon BA. Spontaneous bacterial peritonitis Pathogenesis, diagnosis, and treatment. Gastroenterologist 1995 3 311-328. 

Runyon B. Ascites and spontaneous bacterial peritonitis. In Eeldman M, Scharschmidt BE, Sleisenger MH, eds. Sleisenger and Eordtran s Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Treatment, 6th ed. Philadelphia, Saunders, 1998 1310-1333. 

The usual duration of therapy for peritonitis associated with CAPD is 10 to 14 days, but up to 3 weeks of therapy may be required. Antimicrobial therapy should be continued until dialysate fluid is clear, cultures are negative for 2 to 3 days, and the patient is asymptomatic. When parenteral agents are administered, the initial dose would be the same as that for patients with normal renal function, whereas subsequent doses should be much less or given less frequently for renally excreted agents and should account for possible loss through peritoneal dialysis. Serum concentrations should be performed for aminoglycosides and vancomycin. Some studies have demonstrated that for patients with spontaneous bacterial peritonitis associated with cirrhotic ascites, treatment duration may be as short as 5 days when ascitic fluid polymorphonuclear cell counts are used to guide treatment. 

Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. Gastroenterology 1991 100 1737-1742. 

Uses Rifaximin is a non-systemic, gut-selective antibiotic and has been approved in the USA for reducing the risk of recurrence of hepatic encephalopathy in adults. The effects of rifaximin 400-1200 mg/day have been assessed in a retrospective study after treatment with lactulose 20-120 g/day in improving hospitalization outcomes in 65 patients with hepatic encephalopathy [17 ]. Rifaximin reduced the risk, number, and duration of hospitalizations for hepatic encephalopathy compared with lactulose. Fewer patients had evidence of spontaneous bacterial peritonitis while taking rifaximin. Lactulose was associated with many adverse events, including abdominal cramps (n = 2l), bloating ( = 8), pain ( = 19), and excessive diarrhea ( = 54) in contrast, there was only one case of abdominal pain in those who took rifaximin. 

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