RANDOMIZED TRIAL COMPARING CEFTRIAXONE WITH CEFONICID FOR TREATMENT OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC-PATIENTS

We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h ) for their efficacy and safety in treating spontaneous bacterial peri tonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic char acteristics were similar in both groups. Ceftriaxone-susceptible strai ns were isolated on 44 occasions (94%), and cefonicid-susceptible stra ins were isolated on 43 occasions (91.5%). The antibiotic concentratio n in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100% of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid grou p and 30% in the ceftriaxone group (P was not significant). The time t hat elapsed between the initiation of treatment and the patient's deat h was shorter in the cefonicid group patients (5.3 +/- 3.90 days) than in the ceftriaxone group patients (11.8 +/- 9.15 days) (P < 0.05). No ne of the patients presented with superinfections, and only two patien ts treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans . Ceftriaxone and cefonicid are safe and useful agents for treating ci rrhotic spontaneous bacterial peritonitis, although the pharmacokineti c characteristics of ceftriaxone seem to be more advantageous than tho se of cefonicid.