TY - JOUR
T1 - Response-Guided Therapy With Cefotaxime, Ceftriaxone, or Ciprofloxacin for Spontaneous Bacterial Peritonitis
T2 - A Randomized Trial: A Validation Study of 2021 AASLD Practice Guidance for SBP
AU - Yim, Hyung Joon
AU - Kim, Tae Hyung
AU - Suh, Sang Jun
AU - Yim, Sun Young
AU - Jung, Young Kul
AU - Seo, Yeon Seok
AU - Kang, Seong Hee
AU - Kim, Moon Young
AU - Baik, Soon Koo
AU - Kim, Hong Soo
AU - Kim, Young Seok
AU - Park, Soo Young
AU - Kim, Byung Ik
AU - Park, Jun Yong
AU - Heo, Jeong
AU - Sohn, Joo Hyun
AU - Heo, Nae Yun
AU - Han, Kwang Hyub
AU - Um, Soon Ho
N1 - Publisher Copyright:
Copyright © 2023 by The American College of Gastroenterology.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Introduction: For the treatment of spontaneous bacterial peritonitis (SBP), cefotaxime, ceftriaxone, and ciprofloxacin were used as first-line agents. However, considering the increasing rate of antibiotic resistance, it is unclear which of these drugs can be initially recommended. This study aimed to compare the current efficacy of the 3 antibiotics, namely cefotaxime, ceftriaxone, and ciprofloxacin, for the treatment of SBP in patients with cirrhosis with ascites, when guided by therapeutic responses. Methods: This study was a multicenter, prospective, randomized controlled trial. The inclusion criteria were 16- to 75-year-old patients with liver cirrhosis with ascites, having polymorphonuclear cell count of >250/mm3. We performed a follow-up paracentesis at 48 hours to decide continuing or changing the assigned antibiotics and then assessed the resolution rates at 120 and 168 hours of treatment. Results: A total of 261 patients with cirrhosis who developed SBP were enrolled. Most of the patients were diagnosed as those with SBP within 48 hours of admission. The resolution rates at 120 hours, which is the primary endpoint, were 67.8%, 77.0%, and 73.6% in the cefotaxime, ceftriaxone, and ciprofloxacin groups, respectively (P = 0.388), by intension-to-treat analysis. The 1-month mortality was similar among the groups (P = 0.770). The model for end-stage liver disease score and the SBP resolution were significant factors for survival. Conclusion: The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.
AB - Introduction: For the treatment of spontaneous bacterial peritonitis (SBP), cefotaxime, ceftriaxone, and ciprofloxacin were used as first-line agents. However, considering the increasing rate of antibiotic resistance, it is unclear which of these drugs can be initially recommended. This study aimed to compare the current efficacy of the 3 antibiotics, namely cefotaxime, ceftriaxone, and ciprofloxacin, for the treatment of SBP in patients with cirrhosis with ascites, when guided by therapeutic responses. Methods: This study was a multicenter, prospective, randomized controlled trial. The inclusion criteria were 16- to 75-year-old patients with liver cirrhosis with ascites, having polymorphonuclear cell count of >250/mm3. We performed a follow-up paracentesis at 48 hours to decide continuing or changing the assigned antibiotics and then assessed the resolution rates at 120 and 168 hours of treatment. Results: A total of 261 patients with cirrhosis who developed SBP were enrolled. Most of the patients were diagnosed as those with SBP within 48 hours of admission. The resolution rates at 120 hours, which is the primary endpoint, were 67.8%, 77.0%, and 73.6% in the cefotaxime, ceftriaxone, and ciprofloxacin groups, respectively (P = 0.388), by intension-to-treat analysis. The 1-month mortality was similar among the groups (P = 0.770). The model for end-stage liver disease score and the SBP resolution were significant factors for survival. Conclusion: The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.
KW - ASCITES
KW - antibiotics
KW - comparison
KW - empirical treatment
KW - liver cirrhosis
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U2 - 10.14309/ajg.0000000000002126
DO - 10.14309/ajg.0000000000002126
M3 - Article
C2 - 36594820
AN - SCOPUS:85151313263
SN - 0002-9270
VL - 118
SP - 654
EP - 663
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 4
ER -