H. Savli et al., SPONTANEOUS BACTERIAL PERITONITIS - A SERIOUS PROBLEM IN PATIENTS WITH ASCITES, European journal of gastroenterology & hepatology, 4(3), 1992, pp. 165-171
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.