Spontaneous bacterial peritonitis (SBP) is a severe infectious complication in cirrhotic patients, and initial antibiotic therapy must be empirical. An initial study published in 1985 found that cefotaxime administered at a dose of 2 g every 4 h was more effective and safer than the combination of tobramycin-ampicillin.
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Which is better cefotaxime or ceftriaxone?
ABSTRACT Ceftriaxone has a higher biliary elimination than cefotaxime (40% versus 10%), which may result in a more pronounced impact on the intestinal microbiota. We performed a monocenter, randomized open-label clinical trial in 22 healthy volunteers treated by intravenous ceftriaxone (1 g/24 h) or cefotaxime (1 g/8 h) for 3 days.
How effective is ceftriaxone for treating Enterobacteriaceae?
Ceftriaxone has been effective in treating infections due to other 'difficult' organisms such as multidrug-resistant Enterobacteriaceae.
What is the efficacy of cefotaxime for the treatment of bacterial sepsis?
An initial study published in 1985 found that cefotaxime administered at a dose of 2 g every 4 h was more effective and safer than the combination of tobramycin-ampicillin. Since then, cefotaxime has been considered the agent of choice in the empiric therapy of SBP.
Can cefotaxime prevent the spread of AmpC-hyperproducing Enterobacteriaceae?
Fighting the spread of AmpC-hyperproducing Enterobacteriaceae: beneficial effect of replacing ceftriaxone with cefotaxime. J Antimicrob Chemother69:786–789. doi:10.1093/jac/dkt403.
What antibiotics treat Spontaneous bacterial peritonitis?
The empirical treatment of SBP consists of any of a number of cephalosporins, such as cefotaxime (Claforan), ceftriaxone (Rocephin), ceftizoxime (Cefizox), or amoxicillin–clavulanic acid (e.g., an IV formulation in Europe).
How is Spontaneous bacterial peritonitis treated?
For spontaneous bacterial peritonitis (SBP), a 10- to 14-day course of antibiotics is recommended. Although not required, a repeat peritoneal fluid analysis is recommended to verify declining PMN counts and sterilization of ascitic fluid.
When do you treat Spontaneous bacterial peritonitis?
In patients with suspected spontaneous bacterial peritonitis (SBP), empiric therapy should be initiated as soon as possible to maximize the patient's chance of survival [3]. However, antibiotics should not be given until ascitic fluid has been obtained for culture.
How is SBP Spontaneous bacterial peritonitis diagnosed?
Spontaneous bacterial peritonitis (SBP) is infection of ascitic fluid without an apparent source. Manifestations may include fever, malaise, and symptoms of ascites and worsening hepatic failure. Diagnosis is by examination of ascitic fluid. Treatment is with cefotaxime or another antibiotic.
What is prophylaxis for spontaneous bacterial peritonitis?
Recommended regimens for primary and secondary SBP prophylaxis consist of oral ciprofloxacin 500 mg daily or trimethoprim-sulfamethoxazole one double-strength tablet daily. Daily dosing is preferred over intermittent dosing due to the increased risk of developing antimicrobial resistance with intermittent dosing.
Why is it called spontaneous bacterial peritonitis?
Spontaneous bacterial peritonitis is an infection of abdominal fluid, called ascites, that does not come from an obvious place within the abdomen, such as a hole in the intestines or a collection of pus.
Is cefotaxime broad spectrum?
Cefotaxime is a broad-spectrum antibiotic that is FDA-approved and indicated to treat gram-positive, gram-negative, and anaerobic organisms of susceptible strains causing pneumonia, urinary tract infections, cervicitis, endometritis, urethritis, and sepsis.
What is spontaneous bacterial?
INTRODUCTION. Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source [1].
Does cefepime treat SBP?
Conclusions: In hospitalized cirrhotics with SBP and risk factors for treatment failure, cefepime showed comparable efficacy and survival to imipenem. Non-response to therapy at 48 h is a reliable predictor of treatment failure and mortality. Antibiotic combinations and novel options are needed for these patients.
What bacteria causes Spontaneous bacterial peritonitis?
Escherichia coli, streptococci (mostly pneumococci), and Klebsiella cause most episodes of spontaneous bacterial peritonitis in patients who are not receiving selective intestinal decontamination (Garcia-Tsao 1992).
How does SBP calculate PMNs?
The absolute PMN count is calculated by multiplying the total white blood cell count (or total "nucleated cell" count) by the percentage of PMNs in the differential. The cell count and differential are performed manually without formal quality control.
How do you interpret ascitic fluid in SBP?
A high SAAG (>1.1g/dL) suggests the ascitic fluid is a transudate. A low SAAG (<1.1g/dL) suggests the ascitic fluid is an exudate.
What is ceftriaxone?
Ceftriaxone. A review of its antibacterial activity, pharmacological properties and therapeutic use. Ceftriaxone. A review of its antibacterial activity, pharmacological properties and therapeutic use.
Is ceftriaxone safe for Gram negative bacteria?
If more widespread use confirms the safety and efficacy of ceftriaxone, it will offer an important alternative, particularly for the treatment of serious infections due to multidrug-resistant Gram-negative bacteria and in situations where the long half-life of the drug could result in worthwhile convenience and cost benefits.
Is ceftriaxone a gram positive or negative?
It is administered intravenously or intramuscularly and has a broad spectrum of activity against Gram-positive and Gram-nega tive aerobic, and some anaerobic, bacteria. The activity of ceftriaxone is generally greater than that of the 'first' and 'second generation' cephalosporins against Gram-negative bacteria, but less than that of the earlier generations of cephalosporins against many Gram-positive bacteria. Although ceftriaxone has some activity against Pseudomonas aeruginosa, on the basis of present evidence it cannot be recommended as sole antibiotic therapy in pseudomonal infections. Ceftriaxone has been effective in treating infections due to other 'difficult' organisms such as multidrug-resistant Enterobacteriaceae. Ceftriaxone was effective in complicated and uncomplicated urinary tract infections, lower respiratory tract infections, skin, soft tissue, bone and joint infections, bacteraemia/septicaemia, and paediatric meningitis due to susceptible organisms. In most of these types of infections once-daily administration appears efficacious. Results were also encouraging in a few patients with ear, nose and throat, intra-abdominal, obstetric and gynaecological infections, and adult meningitis, but conclusions are not yet possible as to the efficacy of the drug in these indications due to limited experience. A single intramuscular dose of ceftriaxone has been compared with standard therapy for gonorrhoea due to non-penicillinase-producing and penicillinase-producing strains of Neisseria gonorrhoeae and shown to be highly effective. In a few small trials the comparative efficacy of ceftriaxone and other antibacterials has been assessed in other types of infections and in perioperative prophylaxis in patients undergoing surgery. Few significant differences in response rates were found between therapeutic groups in these comparative studies, but larger well-designed studies are needed to more clearly assess the comparative efficacy of ceftriaxone and other antimicrobials, especially the aminoglycosides and other 'third generation' cephalosporins, and to confirm the apparent lack of serious side effects with ceftriaxone. If more widespread use confirms the safety and efficacy of ceftriaxone, it will offer an important alternative, particularly for the treatment of serious infections due to multidrug-resistant Gram-negative bacteria and in situations where the long half-life of the drug could result in worthwhile convenience and cost benefits.
Is ceftriaxone effective for gonorrhoea?
A single intramuscular dose of ceftriaxone has been compared with standard therapy for gonorrhoea due to non-penicillinase-producing and penicillinase-producing strains of Neisseria gonorrhoeae and shown to be highly effective.
Is ceftriaxone effective against Pseudomonas aeruginosa
Although ceftriaxone has some activity against Pseudomonas aeruginosa, on the basis of present evidence it cannot be recommended as sole antibiotic therapy in pseudomonal infections. Ceftriaxone has been effective in treating infections due to other 'difficult' organisms such as multidrug-resistant Enterobacteriaceae.