This review provides no clear evidence for the treatment of cirrhotic patients with spontaneous bacterial peritonitis. In practice, third generation cephalosporins have already been established as the standard treatment of spontaneous bacterial peritonitis, and it is clear, that empirical antibiotic therapy should be provided in any case. However, until large, well-conducted trials provide more information, practice will remain based on impression, not evidence.
Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study.
Oral quinolones have been suggested as treatment of cirrhotic patients with uncomplicated spontaneous bacterial peritonitis. To evaluate the efficacy of oral quinolones in all patients with this complication, oral ciprofloxacin after a short course of intravenous (i.v.) ciprofloxacin was compared to i.v. ciprofloxacin.
                Eighty patients were allocated to receive ciprofloxacin i.v. 200 mg/12 h for 7 days (group A, n= 40) or i.v. 200 mg/12 h during 2 days followed by oral 500 mg/12 h for 5 days (group B, n=40). All patients with spontaneous bacterial peritonitis admitted to the hospital were included. Twenty-five variables obtained 48 h after treatment were introduced into univariate and multivariate analyses to identify predictors of survival and outcome.
                In the baseline condition, no differences were found between the two groups in clinical data, hepatic and renal function tests and Child Pugh score. The infection resolution rate was 76.3 % in group A and 78.4 % in group B, and hospital survival was 77.5% in both groups. In multivariate analysis serum creatinine and serum leukocytes 48 h after treatment were associated with prognosis.
                Oral ciprofloxacin after a short course of i.v. ciprofloxacin is effective in the treatment of spontaneous bacterial peritonitis. This regimen can be applied to all patients admitted to the hospital with this complication, and could be an alternative to treating these patients as outpatients.