Comparison of Intravenous Ciprofloxacin and Intravenous Ceftriaxone in the Management of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver
DOI:
https://doi.org/10.51985/Keywords:
Peritonitis; Liver Cirrhosis; Ciprofloxacin; Ceftriaxone; Ascites.Abstract
Objective: To compare the effectiveness of intravenous ciprofloxacin versus intravenous ceftriaxone in spontaneous bacterial peritonitis (SBP) treatment of patients with liver cirrhosis.
Study Design and settings: Randomized controlled trial at Nishtar Hospital Multan/department of medicine.
Methodology: 310 patients aged 25-70 years old who are liver cirrhosed, diagnosed with SBP were enrolled using nonprobability consecutive sampling. Patients were randomly allocated to two groups using lottery approach. Group A (n=155) received the intravenous ciprofloxacin (200 mg twice a day) and Group B (n=155) the intravenous ceftriaxone (1 g twice a day). Efficacy was noted after 48 hours of treatment on the basis of: fever, abdominal pains, and decrease of the neutrophil count in the ascitic fluid; and data was analyzed using SPSS version 26 and chi-square test was applied and considered significant p<0.05.
Findings: Both groups showed an average age of 42.8 +- 9.6 years in Group A and 43.5 +-10.1 years in Group B and an overall efficacy of 71.0% for ciprofloxacin and ceftriaxone of 79.4% respectively and the difference was statistically significant (p=0.048). Ceftriaxone demonstrated superiority in clinical and lab outcome particularly among patients with advanced liver disease.
Conclusion: In comparison to intravenous ciprofloxacin, intravenous ceftriaxone is more effective in treatment of spontaneous bacterial peritonitis in cirrhosis.
References
1. Long B, Gottlieb M. Spontaneous bacterial peritonitis:
Emergency medicine updates. Am J Emerg Med. 2023;70:
84–9. DOI: https://doi.org/10.1016/j.ajem.2023.05.015
2. Hung TH, Tsai CC, Hsieh YH, Tseng CW, Tsai CC, Tsai MC,
et al. Short- and long-term mortality of spontaneous bacterial
peritonitis in cirrhosis. Medicine (Baltimore).
2024;103(50):e40567. DOI: https://doi.org/10. 1097/MD.
0000000000040567
3. Tawheed A, Khan S, Ali M, Rahman A, Iqbal Z, Hussain R,
et al. Exploring the next frontier in diagnosing spontaneous
bacterial peritonitis. World J Hepatol. 2025;17(3):102044.
DOI: https://doi.org/10.4254/wjh.v17.i3.102044
4. Cazacu SM, Popescu M, Ionescu D, Marinescu A, Iliescu D,
Dumitrescu R, et al. Predominant Gram-positive etiology and
antibiotic resistance in spontaneous bacterial peritonitis. Life
(Basel). 2025;15(6):855. doi.org/10.3390/ life15060855
5. Murayama A, Kato S, Yamada T, Suzuki H, Tanaka M, Ito
K, et al. Spontaneous bacterial peritonitis in advanced cirrhosis:
diagnostic advances and outcomes. J Clin Med. 2025;
14(14):5096. DOI: https://doi.org/10.3390/jcm14145096
6. Mohammed Y, Abebe H, Tesfaye B, Alemu T, Bekele D,
Getachew M, et al. Spontaneous bacterial peritonitis and
associated factors among cirrhotic ascites patients. SAGE
Open Med. 2025;13:20503121251366773. DOI: https://doi.org
/10.1177/205031212513667737. Mousa N, Abdel-Razik A, Eldars W, Elhelaly R, Shabana W,
Elzehery R, et al. Risk stratification of spontaneous bacterial
peritonitis recurrence in cirrhotic patients. BMC Gastroenterol.
2025;25:128–35. DOI: https://doi.org/10.1186/s12876-025-
01928-3
8. Wang S, Liu J, Zhang Y, Chen L, Li H, Zhao X, et al. Hepatic
encephalopathy and spontaneous bacterial peritonitis as
predictors of readmission in cirrhosis. Front Med (Lausanne).
2025;12:1417222. DOI: https://doi.org/10.3389/ fmed.2025.
1417222
9. Deepa P, Kumar R, Sharma V, Singh S, Patel A, Verma N, et
al. Shifting microbial landscape of spontaneous bacterial
peritonitis and implications for therapy. Asian J Med Sci.
2026;17(1):45–52. DOI: https://doi.org/10.3126/ ajms.v
17i1.4909
10. Mohammed A, Bello S, Yusuf M, Ibrahim A, Lawal A, Sani
U, et al. Prevalence and microbial spectrum of spontaneous
bacterial peritonitis in cirrhotic patients. Niger Med J.
2025;66(2):210–16. DOI: https://doi.org/10.4103 /nmj.
nmj_910_24.
11. Sheikh MI, Ahmed S, Khan MA, Ali R, Iqbal Z, Hussain M,
et al. Comparative efficacy of ciprofloxacin and ceftriaxone
in spontaneous bacterial peritonitis. Pak J Health Sci.
2024;5(2):210–15. DOI: https://doi.org/10.54393
/pjhs.v5i2.2047
12. Teutli-Carrión S, Martínez-Rodríguez LA, García-Juárez I,
Hernández-Avila M, López-Gómez J, Pérez-Hernández JL,
et al. Impact of spontaneous bacterial peritonitis on outcomes
in cirrhosis. Ann Hepatol. 2024;29:101234. DOI: https://
doi.org/10.1016/j.aohep.2024.101234
13. Cazacu SM, Popescu M, Ionescu D, Marinescu A, Iliescu D,
Dumitrescu R, et al. Etiology and microbiology of spontaneous
bacterial peritonitis. Life (Basel). 2025;15(9):1363. DOI:
https://doi.org/10.3390/life15091363
14. Mohammed Y, Abebe H, Tesfaye B, Alemu T, Bekele D,
Getachew M, et al. Spontaneous bacterial peritonitis and
associated factors among cirrhotic patients. SAGE Open Med.
2025;13:20503121251366773. DOI: https://doi.org/10.
1177/20503121251366773
15. Serper M, Kaplan DE, Mehta R, Taddei TH, Curry MP, Tapper
EB, et al. Outcomes of infections in cirrhosis and SBP
management. Clin Gastroenterol Hepatol. 2024;22(4):789–98.
DOI: https://doi.org/10.1016/j.cgh.2023.05.021
16. Murayama A, Kato S, Yamada T, Suzuki H, Tanaka M, Ito
K, et al. Spontaneous bacterial peritonitis in advanced cirrhosis:
clinical features and prognosis. J Clin Med. 2025;14(14):5096.
DOI: https://doi.org/10.3390/jcm14145096
17. Huang CH, Tsai MS, Hsu YC, Chen CY, Lin HC, Lee FY, et
al. Predictors of treatment response in spontaneous bacterial
peritonitis. Reports. 2022;5(3):18. DOI: https://doi.org/10.3390/
reports5030018
18. Khan MA, Ali K, Zaidi SAR, Shehzad A, Alam I, Rehman
RU, et al. Occurrence of spontaneous bacterial peritonitis in
decompensated cirrhosis. J Popul Ther Clin Pharmacol.
2024;31(6):755–60. DOI: https://doi.org/10.53555/ jptcp.
v31i6.6561
19. Lee CH, Kang HJ, Yu SY, Seo SY, Kim SH, Kim SW, et al.
Initial treatment response and mortality in spontaneous bacterial
peritonitis. Sci Rep. 2023;13:32006. DOI: https://doi.org/10.
1038/s41598-023-32006-8
20. Ahmed S, Farooq U, Iqbal N, Malik F, Riaz M, Tariq H, et
al. Comparative response to antibiotic therapy in spontaneous
bacterial peritonitis. J Coll Physicians Surg Pak.
2023;33(4):456–61. DOI: https://doi.org/10. 29271/jcpsp.
2023.04.456
21. Zhang Y, Liu J, Chen X, Wang L, Zhao H, Li M, et al. Efficacy
of third-generation cephalosporins in SBP: systematic review.
Signa Vitae. 2024;20(2):112–20. DOI: https://doi.org/10.
22514/sv.2024.136
22. Silvey S, Brown RS, Patel V, Kim WR, Nguyen GC, Lee SS,
et al. Antibiotic resistance and recurrence of spontaneous
bacterial peritonitis. Hepatology. 2025;72(3):1120–30. DOI:
https://doi.org/10.1002/hep.39235290
23. DiazGranados D, Tandon P, Garcia-Tsao G, Biggins SW,
Wong F, Runyon BA, et al. Antibiotic strategies for prevention
and treatment of SBP. Clin Transl Gastroenterol.
2025;16(7):e00613. DOI: https://doi.org/10.14309/
ctg.0000000000000613
24. Tawheed A, Yalniz M, Ozercan M, Bahcecioglu IH. Advances
in diagnosis of spontaneous bacterial peritonitis. World J
Hepatol. 2025;17(3):102044. DOI: https://doi.org/10.4254/
wjh.v17.i3.102044
25. Alhajaji R, Alshammari M, Almutairi A, Alotaibi S, Alharbi
A, Alqahtani S, et al. Diabetes mellitus as a risk factor for
spontaneous bacterial peritonitis. Ann Saudi Med.
2024;44(4):272–78. DOI: https://doi.org/10.5144/0256-
4947.2024.272
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