The patient was treated in real time according to the available
A later discussion led to a systematic
review. Clearly, clinicians cannot do a systematic review for every
question raised in their daily experience. Nevertheless, reviewing the
literature in depth enables clinicians to comprehend where practices
stem from, how these are founded on evidence, and sometimes, as in this
case, how frail the evidence is to support routine practices.
We found no convincing evidence concerning efficacy of antibiotics for
spontaneous bacterial peritonitis, and we identified several gaps that
warrant future research. For example, we found no conclusive evidence
to support cefotaxime as the treatment of choice3
recommend quinolones for patients with uncomplicated spontaneous
Until large, well conducted
trials have been published, antibiotic treatment for spontaneous
bacterial peritonitis has to be based on clinical experience.
Randomised trials of spontaneous bacterial peritonitis need to include
several hundred patients in order to have sufficient power. Recruitment
of sufficient patients should be possible given the relatively high
prevalence of cirrhosis complicated by ascites and the incidence of
spontaneous bacterial peritonitis in these patients.3,23
Future trials should also examine long term outcomes, recurrence rate,
long term survival, and the development of resistant pathogens,
particularly with quinolones.