Spontaneous bacterial peritonitis: The clinical challenge of a leaky gut and a cirrhotic liver

Table 1 Important risk factors for spontaneous bacterial peritonitis

Variceal bleeding[15]

Previous SBP[6]

Genetic polymorphisms in the NOD2[55,56], TLR2[61], MCP1[62,63] and FXR[54] gene

Low ascites protein content (below 1-1.5 g/dL)[7]

Advanced liver disease[116]

Intake of proton pump inhibitors[96,97]

SBP: Spontaneous bacterial peritonitis; NOD2: Nucleotide-binding oligomerization domain containing 2; TLR2: Toll like receptor 2; MCP1: Monocyte chemotactic protein 1; FXR: Farnesoid X receptor.

Table 2 Randomised controlled trials concerning antibiotic treatment of spontaneous bacterial peritonitis

Ref.	No. of patients	Study arms	Resolution of infection	P	Comment
Felisart et al[117]	73	Ampicillin + tobramycin vs cefotaxime	56% vs 85%	< 0.02	Also patients without SBP included
Rimola et al[118]	143	Cefotaxime 8 g/24 h vs 4 g/24 h	77% vs 79%	NS
Navasa et al[119]	123	Ofloxacin po vs cefotaxime iv	84% vs 85%	NS	Only patients with uncomplicated SBP included
Ricart et al[120]	48	Amoxicillin-clavulanic acid vs cefotaxime	88% vs 83%	NS
Terg et al[121]	80	Ciprofloxacin only iv vs 2 d iv then po	76 vs 78%	NS
Piano et al[86] (NCT01455246) (preliminary results presented at the AASLD 2014, Abstract 574)	32	Daptomycin + meropenem vs ceftazidime	87% vs 25%	< 0.001	Only patients with nosocomial SBP included

NS: Not significant; SBP: Spontaneous bacterial peritonitis.

Table 3 Randomised controlled trials concerning antibiotic prophylaxis of spontaneous bacterial peritonitis

Ref.	No. of patients	Study arms	Kind of prophylaxis	Occurence of SBP	P
Ginés et al[93]	80	Norfloxacin vs placebo	Secondary	12% vs 35%	0.014
Soriano et al[122]	63	Norfloxacin vs control	Primary/secondary	0% vs 23%	< 0.05
Singh et al[123]	60	Trimethoprim-sulfamethoxazole vs control	Primary/secondary	3% vs 27%	0.025
Grangé et al[124]	107	Norfloxacin vs placebo	Primary	0% vs 9%	NS
Rolachon et al[125]	60	Ciprofloxacin vs placebo	Primary/secondary	4% vs 22%	< 0.05
Novella et al[126]	109	Norfloxacin permanently vs only during hospitalisation	Primary	2% vs 17%	< 0.01
Fernández et al[92]	68	Norfloxacin vs placebo	Primary	7% vs 61%	< 0.001
Terg et al[127]	100	Ciprofloxacin vs placebo	Primary	4% vs 14%	0.076

NS: Not significant; SBP: Spontaneous bacterial peritonitis.