الفهرس 
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Abstract
Spontaneous bacterial peritonitis (SBP) is a potentially fatal complication of cirrhotic ascites, and is diagnosed when the polymorphonuclear leukocytic (PMN) count in the ascitic fluid exceeds 250cells/mm³. Most cases of SBP are due to gut bacteria, such as Escherichia coli and Klebsiella pneumoniae; however, Streptococcal and, infrequently, Staphylococcal infections can also occur. As a result, relatively broad-spectrum therapy is warranted in patients with suspected ascitic fluid infection until the results of susceptibility testing are available (Soares-Weiser et al., 2002).
Nevertheless, cefotaxime or a similar third-generation cephalosporin, are a reasonable choice for suspected SBP, other antibiotics can be used for the treatment of SBP (Cabrera et al., 1982).
Levofloxacin is a fouroquinolone with a broad spectrum covering most of Enterobacteriaceae and some gram positive bacteria. The oral tablets bioavailability is nearly 99 % and it is a suitable and beneficial alternative in the empiric treatment of SBP.
The aim of this work was to compare the therapeutic efficacy of oral levofloxacin 750mg once daily versus intravenous cefotaxime 2gm q8h in the treatment of spontaneous bacterial peritfonitis.
60 patients with SBP were assigned as group A that received levofloxacin 750 mg orally once daily and 60 patients with SBP were assigned group B received cefotaxime 2 gm i.v q8h.
Every participant in each group was subjected to the following:
Detailed history taking, thorough clinical examination, complete blood count and, ESR, liver function tests including (AST, ALT, ALP, total and direct serum bilirubin, INR, LDH, total proteins and serum albumin), serum creat., BUN before and after treatment, abdominopelvic ultrasonography, and ascitic fluid examination for (biochemical assay of ascetic fluid glucose, total proteins, albumin, and LDH, bacteriological culture using aerobic and anaerobic standard blood culture bottles at bedside and PMN count at the start of the study after 2 days from treatment and after 10 days).
The results of this study revealed:
- Abdominal pain was the most presenting symptom in the studied groups.
- The most common organisms isolated in the present study were Gram negative mainly Escherichia coli followed by Klebseilla pneumoniae and the gram positive organisms were Streptococcus pneumoniae and Staphylococcus epidermedis with no significant difference between study groups as regards to ascitic fluid bacterial content and gram stain at the baseline.
- The ascitic fluid bacterial culture conversion from positive to negative culture after 48 hours was statistically highly significant in group A, as 16 (29%) patients with positive culture were reduced to be 5 (9.1%) patients in the form of 2 patient with E-coli, 3 patient with Staphlococcus epidermedis growth. However the culture conversion in group B was statistically non significant as 12 (23%) patients were increased to be 13 (25%) patients in the form of 5 patient with E-coli, 2 patient with Klebsiella pneumoniae, 3 patient with Staphlococci epidermedis, 2 patient with Streptococci pneumoniae growth and the appearance of 1 patient with Acinetobacter growth.
- No significant difference between the studied groups as regards to treatment failure after 48 hours of treatment, as only 2(3.6%) patients in group A in the form of Staphlococcus epidermedis and 6 (11.5%) patients in group B in the form of 2 patient with E-coli growth, one patient with Klebsiella pneumoniae growth, one patient with Streptococcus pneumoniae growth, one patient with Staphlococci epidermidis growth and one patient with Acinetobacter growth.
- The ascitic fluid bacterial culture conversion from positive to negative culture between baseline and day 10 in the studied groups was statistically highly significant in group A as 2(3.8%) patient with one E-coli growth and one Staphlococcus epidermedis growth were present at day 10. However the culture conversion in group B was non significant, as only 4(9.5%) patients in the form of 2 E-coli, one Streptococcus pneumoniae growth and one Staphlococcus epidermedis growth at day 10.
- No significant difference between the studied groups as regards ascitic PML at baseline, however group A had significantly lower levels of ascitic PML at day 2 with a reduction by 90.6% and highly significantly lower levels of ascitic PML at 10 day with a reduction 97.6%. Also the ascitic PML in group B was significantly lower at day 2 with a reduction by 86.7% and lower levels of ascitic PML at 10 day with a reduction 90%. The studied groups had significant reduction of PML throughout the treatment period.
- No statistically significant difference between the studied groups as regard frequency of mortality as 6 (10%) patients in group A and 12(20%) patients in group B.
- No statistically significant difference between the studied groups as medical complications of SBP at the end of treatment, as 3 (5%) patients in group A with GIT bleeding and 5(8.7%) patients in group B in the form of 1(1.7%) patient had hepatic encephalopathy and 4(7%) had GIT bleeding.
- Group A has more significant infection resolution at the end of treatment (96.2%) in comparison to group B (83.3%).