Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis
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Background & aims Treatment of spontaneous bacterial peritonitis currently involves intravenous antibiotic administration. To test the possibility of treating spontaneous bacterial peritonitis with oral antibiotics, oral ofloxacin was compared with intravenous cefotaxime in this infection.Methods One hundred twenty-three cirrhotics with uncomplicated spontaneous bacterial peritonitis (no septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus) were randomly given oral ofloxacin (64 patients) or intravenous cefotaxime (59 patients).Results Infection resolution rate was 84% in the ofloxacin group and 85% in the cefotaxime group. Peak serum levels and trough serum and ascitic fluid levels of ofloxacin and cefotaxime measured on days 3 (23 patients) and 6 (11 patients) of therapy were greater than the minimal inhibitory concentration of isolated organisms. Hospital survival rate was 81% in each group of patients. Blood urea nitrogen and hepatic encephalopathy at diagnosis were associated with prognosis. None of the 36 nonazotemic patients with community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy developed complications during hospitalization, and all were alive at time of discharge.Conclusions Oral ofloxacin is as effective as intravenous cefotaxime in uncomplicated spontaneous bacterial peritonitis. Nonazotemic cirrhotic patients with uncomplicated community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy have an excellent prognosis and may be treated with oral ofloxacin without requiring hospitalization.
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Gram-negative bacteria are the most adept at translocating to mesenteric lymph nodes and are the most frequent cause of spontaneous bacterial infections in cirrhosis patients.
“Gram-negative bacteria have been found to be the most adept at translocating to the mesenteric lymph nodes and are the most frequent cause of spontaneous bacterial infections in patients with cirrhosis105–107.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [106]
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- Authors
- Navasa, M., Follo, A., Llovet, J., Clemente, G., Vargas, V, Rimola, A., Marco, F., Guarner, C., Forne, M., Planas, R., Banares, R., Castells, L., Jimenez De Anta, M., Arroyo, V, & Rodes, J.
- Affiliations
- University Hospital Mútua de Terrassa (ES)
- Hospital General Universitario Gregorio Marañón (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Hospital de Sant Pau (ES)
- Hospital Universitari Germans Trias i Pujol (ES)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 1996-10
- Volume
- 111
- Issue
- 4
- Pages
- 1011-1017
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2012654744
- Cited by
- 258
- References
- 7
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 1 · 2019: 18 · 2018: 10 · 2017: 5 · 2016: 10 · 2015: 7 · 2014: 8 · 2013: 10 · 2012: 8
- FWCI
- 3.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- spontaneous bacterial peritonitis, oral antibiotic therapy, liver cirrhosis, hepatic encephalopathy, blood urea nitrogen, prognosis, community-acquired infections, hospital survival
- MeSH terms
- Administration, Oral, Adult, Aged, Aged, 80 and over, Anti-Infective Agents, Bacterial Infections, Cefotaxime, Cephalosporins, Female, Humans, Injections, Intravenous, Male, Middle Aged, Peritonitis, Ofloxacin
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