الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
To verify effectiveness of standard cefotaxime as 1st line of treatment of SBP episodes and finding the effect of different antibiotic regimens (meropenem&levofloxacin) in treatment of SBP episodes resistant to standard cefotaxime.
Methods: SBP episode occurred in 100cirrhotic patients were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was >
250 cells/mm3, and empirically treated with cefotaxime, patients were divided into two groups according to response to cefotaxime.
Results: patients were divided into two groups sensitive group to cefotaxime(I) and resistant group to cefotaxime(II) , mean age for sensitive group(49.4+_7.74) years, and percentage of male/female (59.3%/40.7%).In resistant group mean age(51.5+_8.08)years and male/female ratio(57.9%/42.1).ascitic fluid culture was positive in (32 %) of cases only,treatment with cefotaxime was successful in 81% of cases, while 19% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy was empirically by meropenem and gave response in 11out of 11patients (100%)and levofloxacin gave response in 6 out of 8 patients (75%) and 2 patients were treated according to in vitro C&S. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage of 19%. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.
Conclusion: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy, The initial treatment with cefotaxime is considered valid.Meropenem is considered an excellent 1st alternative in cefotaxime resistant cases.
Key words
Spontaneous bacterial peritonitis; Cefotaxime;Antibiotic-resistant pathogens; Ascitic polymorphonuclear count; Cirrhosis;Meropenem;Levofloxacin