Holland D J, Sorrell T C
Department of Infectious Diseases, University of Sydney, Westmead Hospital, New South Wales, Australia.
J Gastroenterol Hepatol. 1993 Jul-Aug;8(4):370-4. doi: 10.1111/j.1440-1746.1993.tb01530.x.
Spontaneous bacterial peritonitis is a frequent and serious infection in cirrhotic patients with ascites. A high index of suspicion is required for early diagnosis and rapid institution of treatment. The common micro-organisms involved in SBP are the aerobic Gram-negative bacilli and Gram-positive cocci that inhabit the intestine. Empiric antibiotic therapy active against these organisms should be instituted as soon as possible to improve survival. Third generation cephalosporins are very effective and safe as the initial empiric antibiotic regimen. Alternatives include beta-lactam-clavulanic acid combinations and other broad-spectrum antibiotics, although cost benefit considerations are important in selection. If cultures and susceptibility tests allow, antibiotic therapy should be altered to provide optimum narrow-spectrum and cost-effective treatment. Recent evidence suggests that (at least in the case of cefotaxime), 5-day treatment is equally effective as 10-day treatment. Except in patients awaiting liver transplantation, antibiotic prophylaxis of SBP is not recommended at present, as the few trials performed have not been able to demonstrate superior results for survival, hospital admissions or cost-effectiveness, over prompt diagnosis and therapy of individual episodes of SBP.
自发性细菌性腹膜炎是肝硬化腹水患者常见且严重的感染。早期诊断和迅速开始治疗需要高度的怀疑指数。参与自发性细菌性腹膜炎的常见微生物是存在于肠道的需氧革兰氏阴性杆菌和革兰氏阳性球菌。应尽快开始针对这些微生物的经验性抗生素治疗，以提高生存率。第三代头孢菌素作为初始经验性抗生素方案非常有效且安全。其他选择包括β-内酰胺-克拉维酸组合和其他广谱抗生素，不过在选择时成本效益考量很重要。如果培养和药敏试验可行，应调整抗生素治疗以提供最佳的窄谱且具成本效益的治疗。最近的证据表明（至少在头孢噻肟的情况下），5天治疗与10天治疗同样有效。除了等待肝移植的患者外，目前不建议对自发性细菌性腹膜炎进行抗生素预防，因为所进行的少数试验未能证明在生存率、住院率或成本效益方面，相较于对自发性细菌性腹膜炎个体发作进行及时诊断和治疗有更优结果。
