Imipenem Versus Cefepime in Spontaneous Bacterial Peritonitis and to Evaluate the Risk Factors for Treatment Failure

Study Overview
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Brief Summary
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All consecutive patients with Cirrhosis and ascites admitted to ILBS (Institute of Liver & Biliary Sciences) will be evaluated for the presence of SBP (Spontaneous Bacterial Peritonitis) by ascitic fluid examination at admission. SBP (Spontaneous Bacterial Peritonitis) will be diagnosed in the presence of absolute neutrophil count (ANC >250/mm3) with/without positive ascitic fluid culture and Patients with SBP (Spontaneous Bacterial Peritonitis) included in the study will be randomized to receive cefepime or imipenem. However, other SBP (Spontaneous Bacterial Peritonitis) patients not included for randomization will be given empirical therapy with 3rd generation cephalosporin (ceftriaxone).

Detailed Description
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Baseline evaluation: Baseline clinical, laboratory and disease severity parameters will be evaluated for each study patient. Etiology of cirrhosis. Severity of liver disease. CTP (Child-Turcotte-Pugh) score MELD (Model for End-stage Liver Disease) score MELD (Model for End-stage Liver Disease)-Na score IMSAA score Decompensations/complications of CLD (Chronic Liver Disease) UGI bleed, Hepatic encephalopathy, AKI (Acute Kidney Injury) etc. Laboratory investigations: Serum electrolytes Liver function tests Kidney function tests Pro calcitonin USG/CT abdomen Complete blood counts Coagulation parameters Ascitic fluid analysis- TLC, DLC, Protein, sugar, culture, SAAG. Chest X ray PA view HBsAg and Anti-HCV and other etiological workup as available.

Official Title
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A Randomized, Comparative Open Label Study of Imipenem Versus Cefepime in Spontaneous Bacterial Peritonitis and to Evaluate the Risk Factors for Treatment Failure.

Conditions
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Spontaneous Bacterial Peritonitis

Intervention / Treatment
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* Drug: cefepime + Albumin
* Drug: Imipenem + Albumin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Cirrhotic Patients with SBP (Spontaneous Bacterial Peritonitis) having any of the following risk factors would be considered as 'Difficult to Treat SBP' and would be included - Nosocomial SBP: occurence of SBP (Spontaneous Bacterial Peritonitis) after 48 hours of hospital admission, or Prior ascitic fluid infection with 3rd generation cephalosporin resistant organism, or No response to treatment with 3rd generation cephalosporins after 48 hours. Exclusion Criteria: Age less than 18 years. Cirrhotics with SBP (Spontaneous Bacterial Peritonitis) managed as outpatients. Post liver transplant, HIV patients. Patients on systemic chemotherapy, immunosuppressant drugs. Growth of bacteria resistant to intervention drugs in ascitic fluid culture.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: cefepime + Albumin<br>cefepime 1g iv 8 hourly + Albumin will be given for 2 days. | Drug: Imipenem + Albumin<br>* Imipenem + Albumin will be given for 2 days.<br>|
| Active Comparator: Imipenem + Albumin<br>Imipenem 1g iv 8 hourly + Albumin will be given for 2 days. | Drug: cefepime + Albumin<br>* cefepime + Albumin will be given for 2 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome of the study is the Response to treatment in each intervention group. Response is defined as 25% reduction in ANC (Absolute Neutrophil Count) from baseline. |  | 2 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival |  | 15 days,1 month and 3 months |