EXPERIENCE WITH CEFOTAXIME IN THE TREATMENT OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOSIS

Spontaneous bacterial peritonitis (SEP) is a severe infectious complic ation in cirrhotic patients, and initial antibiotic therapy must be em pirical. An initial study published in 1985 found that cefotaxime admi nistered at a dose of 2 g every 4 h was more effective and safer than the combination of tobramycin-ampicillin. Since then, cefotaxime has b een considered the agent of choice in the empiric therapy of SEP. Subs equent publications showed that a dosage of 2 g every 6 h was also ade quate in this infection. More recent studies have demonstrated that th e high efficacy of cefotaxime in SEP can be maintained by using lower dosages than those used in initial investigations. In one of these stu dies, a dose of 2 g every 8 h for 5 days was found to be as effective as the same dose for 10 days. Finally, a prospective, randomized multi center trial aimed at comparing the efficacy of two different dosages of cefotaxime, 2 g every 6 h versus 2 g every 12 in a large series of cirrhotic patients with SEP, showed that both dosages resulted in simi lar rates of resolution of infection and survival. Despite the reasona bly adequate rate of infection resolution in SEP : patients, the in-ho spital mortality rate remains high as a result of complications such a s renal failure. Further studies should therefore be addressed to redu cing the incidence of these complications and thus improving survival.