tailieunhanh - The Intensive Care Manual - part 8

Bảo hiểm kháng sinh cho huyết áp tâm thu được tương đối rộng trong quang phổ, cho đến khi kết quả của nền văn hóa và nhạy cảm trở nên có sẵn. Cefotaxime hoặc tương tự như cephalosporin thế hệ thứ ba vẫn là lựa chọn | 11 Gastrointestinal Problems 279 Antibiotic coverage for SBP should be relatively broad in spectrum until the results of cultures and sensitivities become available. Cefotaxime or a similar third-generation cephalosporin remain the treatment of choice for SBP since they cover the most common pathogens Escherichia coli Klebsiella pneumoniae and Anaerobic organisms are rarely identified as a cause of SBP. Recently a randomized controlled trial has shown that 5 days of antibiotic therapy is as effective as 10 days of such therapy in well-characterized SBP with or without A repeated paracentesis in 2 or 3 days is usually not necessary although it may be useful when a patient fails to improve or secondary bacterial peritonitis is a consideration. Risk factors for developing SBP include low opsonin levels in conjunction with ascitic total protein levels of less than g dL recent variceal bleeding especially if hypotension occurs and a previous episode of The use of norfloxacin 400 mg day orally has been shown to prevent SBP in patients with low ascitic total protein levels . low opsonins and a previous history of 116 However oral antibiotics do not prolong survival and can select for resistant gut flora. In fact the long-term use of ciprofloxacin was identified in a recent report as an important risk factor for developing fungal Intermittent doses of ciprofloxacin 750 mg week and using norfloxacin only for inpatients may prevent SBP without selecting for resistant 119 Until randomized trials can document cost savings or survival benefits the use of long-term antibiotic prophylaxis should only be considered in those with risk factors for developing SBP and in those awaiting liver transplantation. Diuresis may actually help prevent SBP by increasing ascitic fluid opsonins complement and antibody levels whereas repeated large-volume paracentesis LVP may remove opsonins and thereby increase the .