Oral Levofloxacin Versus Intravenous Cefotaxime in the Treatment of Patients with Spontaneous Bacterial Peritonitis: A Randomized Controlled Trial

Objectives: Spontaneous bacterial peritonitis is a frequent complication in patients with liver cirrhosis and ascites. Intravenous Cefotaxime is a reasonable choice for suspected SBP but certain oral agents as oral oftoxacin, 400mg twice daily may be as effective as parenteral therapy.Aim of the Work: To compare the therapeutic and cost effectiveness of oral levofloxacin 750mg once daily versus intravenous cefotaxime 2gm/8h in the treatment of cirrhotic patients with SBP.Patients and Methods: 80 patients with decompensated chronic liver diseases and ascites confirmed to have SBP were enrolled in this study. Patients were randomized into two groups; each group consists of 40 patients. Group 1 treated with cefotaxime 2gm i.v/8h for 5 days and Group 2 treated with levofloxacin 750mg orally once daily also for 5 days. All patients were subjected to: Liver profile, serological tests for viral markers, abdominal ultrasound, modified Child s Pugh score, and ascitic fluid analysis (chemical, microscopical microbiological) at baseline, after 48 hours and at the end from the start of treatment.Results: The baseline ascitic PML of group I was 640 cells/ml³ and of group II was 655 cells/ml³. The PML count was markedly decreased after 48 hours and after 5 days of treatment compared to the baseline count in both groups (p 0.001). Negative growth was found in 67.5% of the total patients, 70% of group I, and 65% of group II whereas positive growth was found in 32.5% of the total patients, 30% of groupI,and 35% of group II. In group I, the number of negative growth increased from 28 before to 35 after treatment with no significant difference (p 0.05) and the positive ascitic fluid cultures were decreased from 12 to 5 after treatment also with no significant difference (p 0.05) while in groupII,the number of negative growth were significantly increased from 26 before to 36 after treatment (p 0.05) and the positive ascitic fluid cultures were significantly decreased from 14 before to 4 after treatment (p 0.05). 7 cases in group I and 6 cases in group II failed to respond to treatment. Infection resolution occurred in 33 (82.5%) patients in group I and in 34 (85%) patients in group II.Conclusion: Oral levofloxacin is comparable to i.v. cefotaxime in the treatment of SBP. Oral levofloxacin is also cheeper than i.v. cefotaxime, and the oral route and single daily dose is more convenient to the patient than intravenous route.