Article type
Year
Abstract
Background: Spontaneous bacterial peritonitis (SBP) is a complication of cirrhotic ascites that occurs in the absence of any intra-abdominal, surgically treatable source of infection. Antibiotics, particularly cephalosporins and quinolones, are extensively used both as treatment and/or for prophylaxis of SBP in cirrhotic patients.
Objectives: To evaluate the effectiveness of different types and different modes of administration of antibiotics in the treatment for SBP, and in prophylaxis of SBP in cirrhotic patients with gastrointestinal bleeding.
Search strategy: Electronic searches on the Cochrane Library (Issue 1, 2000), the Cochrane Hepato-Biliary Group's Trials Register (March 2000), EMBASE (1980-2000), MEDLINE (1966-2000); handsearching the references of all identified studies; contacting the first author of each included trial. Selection criteria: Randomised studies comparing different types of antibiotics for treatment and prophylaxis of SBP in cirrhotic patients.
Data collection & analysis: Data were independently extracted from these trials by at least two reviewers. Peto odds ratios (OR) or average differences, with their 95% confidence intervals (CI) were estimated. The reviewers assumed an "intention-to-treat" basis for the outcome measures.
Main results: 15 trials were found assessing antibiotic therapy in SBP (8 included) and 9 assessing antibiotic prophylaxis of SBP (6 included). For antibiotic therapy of SBP: cephalosporins did not significantly differ from other antibiotics in curing the infection (OR 0.56 [0.28, 1.11]), or in preventing mortality (OR 0.78 [0.40, 1.51]). The results of comparisons of intravenous with oral administration, or short with long-term duration of treatment, are inconclusive, as each trial used different antibiotics, the results could not be combined. Trials evaluating antibiotic prophylaxis showed that antibiotics (mainly quinolones) have an important impact in reducing the incidence (OR 0.23 [0.16, 0.32]) of SBP, and mortality for all causes (OR 0.40 [0.24, 0.65]).
Reviewers' conclusions: Up to now, there Is no evidence that cephalosporins are more effective, or cause less mortality and adverse events, than other antibiotics in the treatment of SBP. A randomised trial with a larger sample size, and evaluating different modes of administration and durations of treatment should be planned. There is good evidence to LEFT the use of antibiotic prophylaxis in patients with cirrhosis and gastrointestinal bleeding, in order to reduce the incidence of SBP and of mortality.
Objectives: To evaluate the effectiveness of different types and different modes of administration of antibiotics in the treatment for SBP, and in prophylaxis of SBP in cirrhotic patients with gastrointestinal bleeding.
Search strategy: Electronic searches on the Cochrane Library (Issue 1, 2000), the Cochrane Hepato-Biliary Group's Trials Register (March 2000), EMBASE (1980-2000), MEDLINE (1966-2000); handsearching the references of all identified studies; contacting the first author of each included trial. Selection criteria: Randomised studies comparing different types of antibiotics for treatment and prophylaxis of SBP in cirrhotic patients.
Data collection & analysis: Data were independently extracted from these trials by at least two reviewers. Peto odds ratios (OR) or average differences, with their 95% confidence intervals (CI) were estimated. The reviewers assumed an "intention-to-treat" basis for the outcome measures.
Main results: 15 trials were found assessing antibiotic therapy in SBP (8 included) and 9 assessing antibiotic prophylaxis of SBP (6 included). For antibiotic therapy of SBP: cephalosporins did not significantly differ from other antibiotics in curing the infection (OR 0.56 [0.28, 1.11]), or in preventing mortality (OR 0.78 [0.40, 1.51]). The results of comparisons of intravenous with oral administration, or short with long-term duration of treatment, are inconclusive, as each trial used different antibiotics, the results could not be combined. Trials evaluating antibiotic prophylaxis showed that antibiotics (mainly quinolones) have an important impact in reducing the incidence (OR 0.23 [0.16, 0.32]) of SBP, and mortality for all causes (OR 0.40 [0.24, 0.65]).
Reviewers' conclusions: Up to now, there Is no evidence that cephalosporins are more effective, or cause less mortality and adverse events, than other antibiotics in the treatment of SBP. A randomised trial with a larger sample size, and evaluating different modes of administration and durations of treatment should be planned. There is good evidence to LEFT the use of antibiotic prophylaxis in patients with cirrhosis and gastrointestinal bleeding, in order to reduce the incidence of SBP and of mortality.