SPONTANEOUS BACTERIAL PERITONITIS - AN UPDATE

Objective: To describe spontaneous bacterial peritonitis (SEP) in the context of currently accepted criteria for diagnosis, treatment, and p revention. Design: A review of SEP and its associated etiopathogenic f actors is presented. Material and Methods: Numerous studies on mechani sms of disease, diagnosis, treatment, and prevention are discussed, Di agnostic and therapeutic algorithms are presented. Results: Peritoniti s in patients with ascites in the absence of secondary causes, such as perforation of a viscus, occurs primarily in patients with end-stage liver disease, Enteric organisms, mainly gram-negative bacilli, probab ly translocate to regional lymph nodes to produce bacteremia and seedi ng of ascitic fluid, Signs and symptoms of peritonitis are usually sub tle, The ascitic fluid polymorphonuclear leukocyte count is the best d eterminant for early diagnosis and treatment of SEP. Third-generation cephalosporins such as cefotaxime are considered the drugs of choice f or treatment, whereas quinolones such as norfloxacin are used to decre ase recurrence. Conclusion: Despite increased awareness, early diagnos is, and prompt and effective antimicrobial therapy, SEP recurs frequen tly and is associated with a high mortality rate, Patients with SEP sh ould be assessed for candidacy for liver transplantation.