Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost.
BACKGROUND
Intravenous administration of a third-generation cephalosporin is optimal antibiotic treatment for spontaneous bacterial peritonitis.


OBJECTIVE
To compare an intravenous-oral step-down schedule with ciprofloxacin (switch therapy) to intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis, and to evaluate the impact of terlipressin and albumin in the treatment of type 1 hepatorenal syndrome on mortality.


METHODS
A total of 116 cirrhotic patients with spontaneous bacterial peritonitis, were randomly given switch therapy with ciprofloxacin (61 patients) or intravenous ceftazidime (55 patients). All patients who developed type 1 hepatorenal syndrome were treated with terlipressin (2-12 mg/day) and albumin (20-40 g/day).


RESULTS
Resolution of infection was achieved in 46/55 patients treated with ceftazidime (84%) and in 49/61 patients treated with ciprofloxacin (80%, P = N.S.). An intravenous-oral step-down schedule was possible in 50/61 patients (82%) who received ciprofloxacin; 45/61 patients (74%) were discharged before the end of antibiotic treatment and completed it at home. The mean saving per patient due to the reduction of hospital stay in the ciprofloxacin group was 1150 . Type 1 hepatorenal syndrome was treated successfully in 12/19 patients (63%). As a consequence, the in-hospital mortality rate due to infection was 10%.


CONCLUSIONS
Switch therapy with cephalosporin is more cost-effective than intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in cirrhotic patients who are not on prophylaxis with quinolones.
Angeli
P
P
Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. pangeli@unipd.it
Guarda
S
S
Fasolato
S
S
Miola
E
E
Craighero
R
R
Piccolo
F
F
Antona
C
C
Brollo
L
L
Franchin
M
M
Cillo
U
U
Merkel
C
C
Gatta
A
A
D000284:Administration, Oral; D000418:Albumins / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D005260:Female; D017048:Health Care Costs; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy* / Q000191:economics; D000077585:Terlipressin
D000418:Albumins; D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D008236:Lypressin; D002939:Ciprofloxacin; D000077585:Terlipressin; D002442:Ceftazidime