[Current treatment of ascites and spontaneous bacterial peritonitis in Spain: analysis of a survey of gastroenterologists and hepatologists].
During the XXII Congress of the Spanish Association for the Study of the Liver a questionnaire was distributed with the aim of describing the current therapeutic attitude of those attending the meeting, concerning two of the most frequent complications of cirrhosis: ascites and spontaneous bacterial peritonitis (SBP). One hundred twelve of the 135 physicians who answered the questionnaire (83%) use to treat tense ascites by therapeutic paracentesis, while 86 physicians (63.7%) managed moderate ascites with diuretics, with spironolactone being the drug most commonly used (n = 117; 87.3%). The most used diuretic schedule for the treatment of ascites was the isolated administration of spironolactone. Frusemide was associated with spironolactone only when moderate or high doses of the latter were found to be insufficient for increasing urinary sodium excretion and eliminating ascites. Following therapeutic paracentesis however, 79 of those surveyed (58.3%) administered a combination of both diuretics on initiation to avoid reaccumulation of ascitic fluid. Sixty-eight of the physicians (50.3%) used transhepatic intrajugular portosystemic shunt in the treatment of refractory ascites. Cefotaxime was the antibiotic most widely used in the treatment of SBP (n = 119; 88%). Most of the physicians surveyed performed prophylaxis of this infection (generally by the oral administration of norfloxacin) in patients with a previous history of SBP (n = 125; 92.6%) or an episode of gastrointestinal hemorrhage (n = 108; 80%) but not in those patients with no previous history of SBP and with low protein concentrations in the ascitic fluid (n = 40; 29.6%). On the appearance of SBP in patients undergoing prophylactic treatment, cefotaxime remained the antibiotic of choice (n = 104; 79%).
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Servicio de Hepatología, Hospital Clínic i Provincial, Barcelona.
Ginés
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Navasa
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Arroyo
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V
D001201:Ascites / Q000517:prevention & control / Q000628:therapy*; D001424:Bacterial Infections / Q000517:prevention & control / Q000628:therapy*; D004232:Diuretics / Q000627:therapeutic use; D005762:Gastroenterology; D019538:Health Care Surveys; D006801:Humans; D019152:Paracentesis / Q000706:statistics & numerical data; D010538:Peritonitis / Q000517:prevention & control / Q000628:therapy*; D013030:Spain
D004232:Diuretics