The aim of this study was to determine the efficacy of oral
antibiotics in the treatment of severe
infections in
cirrhosis. Twenty-two patients (17 males, 5 females) with spontaneous
bacteremia (n = 7) or bacterial
peritonitis (n = 15) were treated with oral
pefloxacin 400 mg per 24 hr alone (n = 1) or in combination with another oral
antibiotic, trimethoprimsulfamethoxazole (n = 13),
amoxicillin (n = 6),
cefadroxil (n = 2), or
metronidazole (n = 1). In patients with spontaneous
bacteremia, all organisms were found to be sensitive to oral
antibiotics, and a favorable response was elicited in 6 out of 7 (86 p. cent) within 3 days (mean) of treatment. In patients with spontaneous
peritonitis, ascitic fluid cultures were positive in 11 cases, and organisms were sensitive to
pefloxacin in 9 out of 11 cases. A favorable response was elicited in 13 out of 15 within 2 to 8 days of treatment. Fourteen patients died (64 p. cent), 3 of
infection (
bacteremia n = 1,
peritonitis n = 2), and 11 patients of causes unrelated to
infection, mainly variceal
hemorrhage,
hepatorenal syndrome or
hepatocellular carcinoma, although the clinical symptoms of
infection were controlled. One-year survival was 57 p. cent in patients with
bacteremia and 33 p. cent in those with bacterial
peritonitis. Oral treatment was well tolerated in all patients. We suggest that most
bacteremia and spontaneous bacterial
peritonitis in cirrhotic patients can be treated with oral
antibiotics. In some patients, this may be accomplished on an out patient basis.