Monday March 30, 2009
Antibiotic duration for spontaneous bacterial peritonitis. Is it evidence or just the gut feeling?

Recent Cochrane review by Chavez-Tapia helps to sort this out.

This systematic review looked at the randomized clinical trials on the treatment of spontaneous bacterial peritonitis from as far back as 1945 to July 2008. Thirteen studies were included; each one of them compared different antibiotics in their experimental and control groups. No meta-analyses could be performed, though data on the main outcomes were collected and analyzed separately for each included trial. Currently, the evidence showing that lower dosage or short-term treatment with third generation cephalosporins is as effective as higher dosage or long-term treatment is weak. Oral quinolones could be considered an option for those with less severe manifestations of the disease.

Author’s opinion: Until large clinical trials are done practice remains based on impression rather then evidence. In practice, third generation cephalosporins have already been established as the standard treatment of spontaneous bacterial peritonitis, and it is clear, that empirical antibiotic therapy should be provided in any case.


Reference: click to get abstract

Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L et al. Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database Syst Rev. 2009; (1):CD002232