Spontaneous bacterial peritonitis

: We describe five patients with spontaneous bacterial peritonitis. The condition is reported more frequently than before and survival has improved. Important clinical features are increasing ascites and unexpected derangement of liver function. Possible predisposing factors, as well as diagnostic and therapeutic measures, are discussed. We emphasize the significance of ascitic polymorph nuclear cell count and bedside inoculation of ascites on blood culture medium, and stress the importance of prompt antibiotic therapy. The choice of empiric antimicrobial treatment is based on the reported frequency of causative agent and toxicity to drugs. Our experience so far indicates that cefotaxime administered as monotherapy is safe and efficient in these patients. Aminoglycosides should be avoided because of increased nephrotoxicity in patients with liver failure.