Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: Results of a prospective, randomized, multicenter study

✍ Scribed by Antoni Rimola; Joan M. Salmerón; Gerardo Clemente; Luis Rodrigo; Antoni Obrador; M. Luisa Miranda; Carlos Guarner; Ramon Planas; Ricard Solá; Victor Vargas; Fernando Casafont; Francesc Marco; Miquel Navasa; Rafael Bañares; Vicente Arroyo; Joan Rodés

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 741 KB
• Volume: 21
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840210312

✦ Synopsis

Cefotaxime (CTX) is considered one of the first-choice antibiotics in the therapy of spontaneous bacterial peritonitis (SBP) in cirrhosis. Because CTX is largely metabolized in the liver, this drug may also be effective in SBP by administering lower doses than those habitually used. To investigate this possibility, a prospective, randomized, multicenter study was performed to compare the therapeutic efficacy of two different dosages of CTX in 143 patients with SBP 71 (group I) were allocated to receive a high dose (2 g every 6 hours, which is one of the most frequently recommended doses in this infection), and 72 (group 11) were allocated to receive a low dose (2 g every 12 hours). At inclusion, both groups were similar in relation to clinical and laboratory data, with the exception of a higher incidence of positive ascitic fluid culture in group I than in group I1 (59% vs. 40%; P = .029). The rate of infection resolution was similar for both groups (77% vs. 79%). Hospital survival was also similar in both groups (69% vs. 79%). No difference was observed between patients with positive or negative ascitic fluid cultures with regard to infection resolution and patient survival. The duration of antibiotic therapy was similar in both groups (9.0 I 3.3 days in group I vs. 8.8 t 3.1 days in group 11). In a subset of 13 patients from group I and 11 patients from group I1 CTX levels were determined in serum (peak and trough) and ascitic fluid (concomitantly with trough serum). Peak serum levels were similar in patients from both groups. In contrast, trough serum andor ascitic fluid levels were significantly lower or more frequently undetectable in group I1 patients than in group I patients. Nevertheless, this Abbreviations: SBP, spontaneous bacterial peritonitis; C T X , cefotaxime; MIC, minimal inhibitory concentration.

From the 'Liver Unit and