Intervention Review

Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients

  1. Norberto C Chavez-Tapia1,*,
  2. Karla Soares-Weiser2,
  3. Mayer Brezis3,
  4. Leonard Leibovici4

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 29 MAY 2007

DOI: 10.1002/14651858.CD002232.pub2


How to Cite

Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L. Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD002232. DOI: 10.1002/14651858.CD002232.pub2.

Author Information

  1. 1

    Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Distrito Federal, Mexico

  2. 2

    Enhance Reviews, Kfar-Saba, Israel

  3. 3

    Hadassah Hebrew University Hospital, Center for Clinical Quality & Safety, Jerusalem, Israel

  4. 4

    Beilinson Campus, Rabin Medical Center, Department of Medicine E, Petah-Tiqva, Israel

*Norberto C Chavez-Tapia, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #5, Mexico City, Distrito Federal, 14000, Mexico. khavez@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Spontaneous bacterial peritonitis is a complication of cirrhotic ascites that occurs in the absence of any intra-abdominal, surgically treatable source of infection. Antibiotic therapy is indicated and should be initiated as soon as possible to avoid severe complications that may lead to death. It has been proposed that empirical treatment should cover gram-negative enteric bacteria and gram-positive cocci, responsible for up to 90% of spontaneous bacterial peritonitis cases.

Objectives

This review aims to evaluate the beneficial and harmful effects of different types and modes of antibiotic therapy in the treatment of spontaneous bacterial peritonitis in cirrhotic patients.

Search methods

We performed electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register (July 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2008), MEDLINE (1950 to July 2008), EMBASE (1980 to July 2008), and Science Citation Index EXPANDED (1945 to July 2008). In addition, we handsearched the references of all identified studies and contacted the first author of each included trial.

Selection criteria

Randomised studies comparing different types of antibiotics for spontaneous bacterial peritonitis in cirrhotic patients.

Data collection and analysis

Data were independently extracted from the trials by at least two authors. Peto odds ratios or average differences, with their 95% confidence intervals, were estimated.

Main results

This systematic review attempted to summarise evidence from randomised clinical trials on the treatment of spontaneous bacterial peritonitis. 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 analysed 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.

Authors' conclusions

This review provides no clear evidence for the treatment of cirrhotic patients with spontaneous bacterial peritonitis. 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. However, until large, well-conducted trials provide more information, practice will remain based on impression, not evidence.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients

Cirrhosis is a severe end-stage liver disease marked by irreversible scarring of liver tissue. Ascites (the accumulation of fluid in the abdomen), is one of the many complications associated with cirrhosis. Ascites is associated with poor quality of life, increased risk of infection, and renal failure. The presence of ascites is a sign of poor prognosis. Spontaneous bacterial peritonitis (inflammation and infection of the membrane that is lining the abdominal cavity) is a complication of cirrhotic ascites that occurs in the absence of any intra-abdominal, surgically treatable source of infection. Antibiotic therapy is indicated and should be initiated as soon as possible to avoid severe complications that may lead to death. This review aimed to evaluate the beneficial and harmful effects of different types and modes of antibiotic therapy in the treatment of spontaneous bacterial peritonitis in cirrhotic patients. Thirteen trials 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 analysed separately for each included trial. Based on the identified evidence, we cannot suggest the most appropriate management to treat spontaneous bacterial peritonitis in regard to the type, dosage, duration, or administration route of the antibiotic therapy. The clinical trials found dealt with different types of antibiotics, and, therefore, could not be combined. This review found no evidence that the effect or safety of one antibiotic is more beneficial than another. Further randomised clinical trials with an adequate design, including a large number of participants and sufficient duration should be carefully planned to provide a more precise estimate of the beneficial and harmful effects of antibiotic treatment for spontaneous bacterial peritonitis.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

抗生素應用於肝硬化自發性細菌性腹膜炎

自發性細菌性腹膜炎是肝硬化腹水的主要併發症,發生在腹腔內,不是來自腹腔內或手術起引的一種感染。抗生素早已被建議為自發性細菌性腹膜炎的主要治療方式。然而,這個建議並非建立在有根據的事實。在治療原則上,也建議抗生素應該涵蓋到革蘭氏陰性腸菌及革蘭氏陽性球菌,足以應付超過90%之病例。

目標

評估抗生素在不同形式和方法下如何有效且安全地治療肝硬化病人的自發性細菌性腹膜炎。

搜尋策略

電子搜尋The Cochrane HepatoBiliary Group Controlled Trials Register (2008,7月), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2008), MEDLINE (1950 – 2008,7月), EMBASE (1980 – 2008,7月),和Science Citation Index EXPANDED (1945 – 2008,7月).並手動搜尋發現試驗的參考文獻,聯絡各納入試驗的第一作者.

選擇標準

隨機試驗,比較不同抗生素用於肝硬化自發性細菌性腹膜炎

資料收集與分析

至少有兩位作者獨立擷取資料.估計Peto OR或平均差及95%CI

主要結論

本系統性回顧試著整理自發性細菌性腹膜炎隨機對照試驗的證據.納入13個試驗,比較比較不同抗生素用於試驗和對照組.無法進行統合分析,但將各試驗資料分開分析.目前,只有微弱證據顯示低劑量或短期第三代cephalosporins和高劑量或長期使用的效果相當.較不嚴重的病患可考慮口服quinolones.

作者結論

此篇回顧沒有提供明確證據,證明肝硬化自發性細菌性腹膜炎治療的療效.臨床上,第三代cephalosporins已經被視為標準療法自發性細菌性腹膜炎,很明顯的,任何情況下都該使用經驗性抗生素治療.但在有大型,完善試驗之前,這些都是根據印象而非實證.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

肝硬化是嚴重末期的肝臟疾病,肝組織不可逆的硬化.腹水(腹部積水)是與硬化有關的併發症之一.腹水與生活品質差,增加感染風險和腎衰竭有關.腹水是預後不佳的跡象.自發性細菌性腹膜炎(腹腔黏膜發炎感染),肝硬化腹水的併發症之一,發生在腹腔內,不是來自腹腔內或手術起引的一種感染。應盡早使用抗生素避免嚴重可能致死的併發症.本回顧想探討不同抗生素種類和療程對肝硬化病人自發性細菌性腹膜炎的益處和可能傷害.納入13個試驗,比較不同抗生素用於試驗和對照組.無法進行統合分析,但將各試驗資料分開分析.由現有證據不能建議何為最適當的抗生素種類和劑量或給藥方式.各試驗使用不同抗生素, 無法合併.本回顧沒有找到某種抗生素的療效或安全性優於其他抗生素的證據.需有隨機試驗,設計好,受試者多,觀察期間要夠長,以估計抗生素治療對自發性細菌腹膜炎的療效和傷害.