Comparative Study between the Efficacy of Oral Gemifloxacin and Intravenous Cefotaxime in Treatment of Spontaneous Bacterial Peritonitis

Background and Aims: Spontaneous bacterial peritonitis (SBP) is defined as a bacterial infection of the ascitic fluid (AF) that arises in individuals without an intra-abdominal source of infection that is surgically curable. SBP is a unique complication in cases with cirrhosis-linked ascites, and it can be so subtle that it is only reported by chance when paracentesis is done. SBP is handled with any of a variety of cephalosporins, such as cefotaxime or quinolones, such as Gemifloxacin. The aim was comparing the effect of oral Gemifloxacin versus intravenous cefotaxime in 60 individuals with cirrhosis who had SBP.

Patients and Methods: The randomized controlled research involved 60 cirrhotic ascitic individuals suffering from SBP admitted to Tropical Medicine Department, Tanta University Hospital. Two groups of patients were investigated: group I included 30 cirrhotic ascitic patient suffering from SBP treated with IV cefotaxime 2gm|8 hours for 7 days and group II included 30 cirrhotic ascetic patient suffering from SBP and treated with oral Gemifloxacin 320 mg once daily for 7 days.

Results: No substantial difference was noted among both groups regarding age, sex, or symptoms, or in laboratory tests such as hemoglobin, total leukocytic count, platelet, serum bilirubin, ALT, AST, albumin, prothrombin activity, INR, creatinine, urea, sodium, and potassium. Also, the outcome was comparable in both groups as regarding the number of treated patients (p=0.781); 20 (66.67%) cases were cured in group I and 21 (70%) cases were cured in group II and in AF analysis after treatment. By using gram stain, gram –ve organism were the predominant in group I 23 (76.7%) and group II 24 (80%) while gram +ve was detected in 7 (23.3%) and 6 (20%) in group I and II respectively. Furthermore, no substantial difference was noted among both groups regarding treatment response based on culture prior to treatment.

Conclusions: Our research is the first to focus on Gemifloxacin use in the management of SBP rather than in the prevention of SBP. Since these agents' relative effectiveness is identical, cost should be the deciding factor. In conclusion, our findings indicate that cefotaxime or Gemifloxacin can be used as a first-line therapy.