Evidence based case report

Antibiotic treatment for spontaneous bacterial peritonitis

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7329.100 (Published 12 January 2002)
Cite this as: BMJ 2002;324:100

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  1. K Soares-Weiser, coordinator of clinical research (ksoares@netvision.net.il)a,
  2. M Paul, senior physiciana,
  3. M Brezis, professorb,
  4. L Leibovici, professora
  1. a Department of Medicine E, Beilinson Campus, Rabin Medical Center, Petah Tikva, 49100, Israel,
  2. b Department of Medicine, Hadassah University Hospital, PO Box 24035, Jerusalem, Israel
  1. Correspondence to: K Soares-Weiser
  • Accepted 27 September 2001

A 55 year old woman, previously diagnosed with cirrhosis secondary to chronic hepatitis C infection, was admitted to our department with fever. She seemed well and had no focal symptoms or signs of infection. As ascites was present, she had paracentesis. This yielded a Gram negative clear fluid with a polymorphonuclear count of 700 cells/mm3. We thought that secondary peritonitis was unlikely and diagnosed spontaneous bacterial peritonitis. She had had no previous episodes or prophylactic antibiotic treatment. Empirical treatment with cefotaxime (2 g every 8 hours) was started.

How did we choose our treatment?

When admitting the patient, the junior doctor had access to two main databases: the Cochrane Library, which contained no relevant information,1 and UpToDate, which recommended intravenous cefotaxime or oral ofloxacin for patients with uncomplicated spontaneous bacterial peritonitis.2

On the morning after her admission, there was a lively discussion at the departmental meeting. The main question was whether the patient could have started taking oral ofloxacin, given her excellent clinical condition. Other questions were raised about the strength of the evidence supporting the standard treatment with cefotaxime and the ideal dose and duration of treatment. We therefore decided to do a systematic review of the literature on antibiotic treatment for spontaneous bacterial peritonitis. …

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