A Randomized Clinical Trial of Short-term vs Long-term Therapy in the Spontaneous Bacterial Peritonitis / 대한간학회지

ABSTRACT

BACKGROUND/AIMS: The standard regimen of SBP is cefotaxime 2 g IV, every 8 hours for 10 days, and the success rate is approximately 90%. It was reported that 5-day therapy was as effective as 10-day therapy, but, generally, the 5-day therapy has not been accepted in practice. This study was done to confirm whether the short-term therapy is as effective as long-term therapy, and additionally whether the opsonin capacity influences the final output of antibiotic therapy. METHODS: Of the 27 patients who met strict criteria for SBP or culture negative neutrocytic ascites, 14 were randomized to a group receiving 5 days and 13 to a group receiving 10 days of single agent cefotaxime 2g IV every 8 hours. Many variables (clinical data, standard liver and kidney function results, ascitic fluid data, complement proteins) were obtained at admission, the 2nd day, and the last day(the 5th or 10th day) of the study. RESULTS: Hospitalization mortality(7% vs 15%), recurrence rate(21% vs 0%), infection related mortality(7% vs 0%) and therapeutic response(86% vs 92%) were not significantly different between the 5- and 10-day treatment groups. The opsonic activity was not significantly different between the recurrence(n=3) group and non-recurrence group(n=26), but the indices of opsonic activity in recurrence group showed lower tendency than those in non-recurrence group. Early response rate was significantly different between the high and low protein concentration in ascitic fluid. CONCLUSIONS: Short course treatment of SBP is as effective as long-course therapy and significantly less expensive.