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Antibiotics for spontaneous bacterial peritonitis in cirrhotics

  • Review
  • Intervention

Authors

  • K Soares-Weiser,

  • M Brezis,

  • L Leibovici


Dr Karla Soares-Weiser, Director, Enhance Reviews, PO Box 137, Kfar-Saba, 44101, ISRAEL. ksoares@netvision.net.il.

Abstract

Background

Spontaneous bacterial peritonitis is mainly a complication of cirrhotic ascites that occurs in the absence of any intra-abdominal, surgically treatable source of infection. Antibiotics have been recommended as the mainstay treatment for spontaneous bacterial peritonitis. However, this recommendation is not based on convincing evidence. It has been proposed that treatment should cover Gram-negative enteric bacteria and Gram-positive cocci, that are responsible for up to 90% of cases.

Objectives

To evaluate the effectiveness and safety of different types and ways of antibiotic therapy for spontaneous bacterial peritonitis in cirrhotic patients.

Search strategy

Electronic searches on the Cochrane Hepato-Biliary Group Trials Register (March 2000), the Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2000), MEDLINE (1966-2000), EMBASE (1980-2000); scanning the references of all identified studies; contacting the first author of each included trial.

Selection criteria

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

Data collection and analysis

Data were independently extracted by two reviewers. Relative risks or weighted mean differences, with their 95% confidence intervals were estimated using 'intention-to-treat' analyses.

Main results

Nine trials dealing with 684 patients diagnosed with spontaneous bacterial peritonitis were included. No placebo-controlled trial was found. Each of the included trials compared different antibiotics, and no meta-analysis could be performed. We were unable to establish the optimal dose or duration of antibiotic therapy and found no convincing evidence that cefotaxime is more effective than ampicillin-tobramycin or that oral quinolones should be recommended for patients 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. Until large, well-conducted, trials provide adequate evidence, treatment must be based on clinical experience.

Plain language summary

Plain language summary

Further evidence about the efficacy and safety of antibiotics in the treatment of spontaneous bacterial peritonitis is needed

Patients with liver disease can accumulate fluids in their abdomen (ascites) and as a result develop a bacterial infection in this fluid. This is called 'spontaneous bacterial peritonitis'. Because spontaneous bacterial peritonitis is a serious condition with high mortality, antibiotics such as cefotaxime, amoxycillin-clavulanic acid, or ofloxacin have previously been recommended to resolve the infection. 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 better than the others.

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