SPONTANEOUS BACTERIAL PERITONITIS - A SERIOUS PROBLEM IN PATIENTS WITH ASCITES

Objective: To point out the importance of spontaneous bacterial perito nitis which is now diagnosed in 18-27% of patients hospitalized with c irrhosis of the liver and ascites and the mortality of which is very h igh and may approach 100% if it remains undiagnosed or if treatment is delayed. Diagnosis: The protein concentration of ascitic fluid can id entify patients at high risk, particularly if it is below 1g/dl. The p olymorphonuclear cell (PMN) count of the ascitic fluid is most importa nt. PMN counts of more than 250 cells/mu-l are diagnostic in the prese nce of a positive bacterial culture. Without positive culture 500 PMNs per mu-l are considered to be diagnostic. Differentiating the spontan eous form from secondary bacterial peritonitis is essential because th e appropriate treatment for the latter is surgical. Management and tre atment: Cefotaxime or a combination of amoxycillin and clavulanic acid appear equally effective for the treatment of spontaneous bacterial p eritonitis with over 80% success rate. Selective intestinal decontamin ation may be useful in some patients. Patients who were already candid ates should be considered for prompt liver transplantation as soon as they have recovered from spontaneous bacterial peritonitis. Conclusion : The possibility of spontaneous bacterial peritonitis should be consi dered in every case of cirrhosis of the liver, since early diagnosis a nd prompt treatment are essential for the patient's survival.