| [ Summary ] |
Spontaneous bacterial peritonitis occurs in patients with advanced liver cirrhosis and is associated with a rapid clinical course and a poor prognosis. It is usually caused by gram-negative bacteria in the intestine such as E.Coli or Klebsiella. The pathogenesis is unclear but may be related to bacterial translocation, impaired reticuloendothelial phagocytic activity and/or low ascitic fluid opsonic activity. The diagnosis of SBP is based on polymorphonuclear cell counts and ascitic fluid cultures. Even when the culuture is negative, cirrhotics with an ascitic fluid polymorphonuclear count greater than 500/microliters, or those with an ascitic fluid polymorphonuclear count greater than 250/microliters and clinical symptpms should be considered to have SBP. Third-generation cephalosporins are the drugs of first choice for treatment, whereas quinolones are used to prevent SBP in high-risk groups, such as patients with gastrointestinal hemorrhage, high serum bilirubin and low ascitic fluid protein concentrations. |