Third-Generation Cephalosporins for Spontaneous Bacterial Peritonitis: Clinical Characteristics for Treatment Response in Cirrhotic Patients: A Cohort Study

Introduction:: For a long time, third-generation cephalosporins (TGCs) have been the first-line therapy for spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, their efficacy has been questioned in recent years. This study aimed to assess the clinical characteristics, bacterial spectrum, initial treatment response, and in-hospital mortality rate among a cohort of Egyptian cirrhotic patients diagnosed with SBP and treated with TGCs. Methods:: A total of 107 cirrhotic patients with SBP were included in this prospective cohort study. All included patients received TGCs as first-line therapy. Baseline characteristics (both clinical and laboratory), initial treatment response, and the rate of in-hospital mortality were documented and compared between treatment responders and nonresponders. Results:: Antibiotic response rate was as follows: 20 patients (18.7%) showed a primary response to TGCs treatment, while 63 (58.9%) showed a response only after switching to more appropriate antibiotics elevatingthe final response to 77.6%. History of repeated attacks of SBP, presence of refractory ascites and elevated alkalinephosphatase levels were significantly more frequent among patients who did not achieve primary response(P= 0.002, 0.048, and 0.029, respectively), with no significant difference concerning the rate of in-hospital mortality among the studied groups (P= 0.276). Regarding ascitic fluid culture, Escherichia coli was the most commonly isolated organism (23%), while no bacterial growth was found among 49 (56.3%) of the non-responders. Discussion:: Increased resistance to TGCs necessitates evaluation of patients' history and clinical assessment to re-escalate antibiotics. Conclusion:: A history of recurrent SBP or the presence of refractory ascites should preclude the use of TGC as first-line therapy in cirrhotic patients with SBP.