The effect of alternative antibiotics versus standard cefotaxime in treatment of spontaneous bacterial peritonitis

To verify effectiveness of standard cefotaxime as 1st line of treatment of SBP episodes and finding the effect of different antibiotic regimens (meropenem&levofloxacin) in treatment of SBP episodes resistant to standard cefotaxime.Methods: SBP episode occurred in 100cirrhotic patients 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, patients were divided into two groups according to response to cefotaxime.Results: patients were divided into two groups sensitive group to cefotaxime(I) and resistant group to cefotaxime(II) , mean age for sensitive group(49.4+_7.74) years, and percentage of male/female (59.3%/40.7%).In resistant group mean age(51.5+_8.08)years and male/female ratio(57.9%/42.1).ascitic fluid culture was positive in (32 %) of cases only,treatment with cefotaxime was successful in 81% of cases, while 19% 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 was empirically by meropenem and gave response in 11out of 11patients (100%)and levofloxacin gave response in 6 out of 8 patients (75%) and 2 patients were treated according to in vitro C&S. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage of 19%. 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 is considered valid.Meropenem is considered an excellent 1st alternative in cefotaxime resistant cases.Key wordsSpontaneous bacterial peritonitis; Cefotaxime;Antibiotic-resistant pathogens; Ascitic polymorphonuclear count; Cirrhosis;Meropenem;Levofloxacin