title: Evaluation of different therapeutic approaches for spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  Spontaneous bacterial peritonitis (SBP) is a significant cause of mortality in cirrhosis. Reducing toxic burden of infected ascitic fluid through paracentesis needs further studies as adjunctive therapy of SBP. We aimed to evaluate different therapies for SBP.
  
  
  METHODS
  Thirty-six cirrhotic ascitic patients with SBP were examined and classified according to treatment modality (5-7 days) into: Group A received cefotaxime, group B received cefotaxime and albumin 1.5 g/kg body weight within 6h of SBP being diagnosed and 1g/kg body weight on day 3, group C received cefotaxime and paracentesis with volume dependent albumin infusion. Control group of 12 cirrhotic ascitic patients free from SBP were included. Routine laboratory tests, ascitic fluid analysis for leucocytes and culture were done, inflammatory mediators such as nitric oxide and tumour necrosis factor alpha were measured in serum and ascitic fluid. Duplex-Doppler assessment of portal flow volume and renal resistive index, Echocardiography to measure end diastolic and end systolic volumes, stroke volume and cardiac output were done. Tests were carried out before and after therapy.
  
  
  RESULTS
  Treatment response was assessed by, cardiac haemodynamics, portal and renal flow and NO and TNF. All studied parameters; laboratory, cardiac, Doppler exhibited a significant improvement in group B in contrast to the other groups as demonstrated by post therapy reduction of (blood and ascitic fluid WBCs & PNLS, serum and ascitic NO & TNF and renal resistive index), elevation of (serum albumin and portal flow volume) and improvement of cardiac haemodynamic.
  
  
  CONCLUSIONS
  Treatment of spontaneous bacterial peritonitis by cefotaxime and body weight based albumin infusion gave most favourable results compared to other regimens. Postulation of removing toxic burden through paracentesis has not been confirmed.
authors.affiliation: Department of Internal Medicine, Zagazig University, Egypt.
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Abd Elaal
authors.forename: Sahar G
authors.initials: SG
authors.lastname: Zaghloul
authors.forename: Hoda Gouda
authors.initials: HG
authors.lastname: Bakr
authors.forename: Mahmmoud Abdou
authors.initials: MA
authors.lastname: Ashour
authors.forename: Hoda
authors.initials: H
authors.lastname: Abdel-Aziz-El-Hady
authors.forename: Naglaa Ali
authors.initials: NA
authors.lastname: Khalifa
authors.forename: Ghada E
authors.initials: GE
authors.lastname: Amr
mesh_terms: D000328:Adult; D000418:Albumins / Q000627:therapeutic use; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D001202:Ascitic Fluid / Q000378:metabolism; D001424:Bacterial Infections / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D002439:Cefotaxime / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000098:blood supply; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D019152:Paracentesis; D010538:Peritonitis / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D011168:Portal System / Q000000981:diagnostic imaging; D012077:Renal Artery / Q000000981:diagnostic imaging; D013318:Stroke Volume; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014463:Ultrasonography
chemical_list: D000418:Albumins; D000900:Anti-Bacterial Agents; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D002439:Cefotaxime