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A causative organism for spontaneous bacterial peritonitis (SBP) often is not recovered, and even when it is found, susceptibility results may be delayed. Updated society guidelines recommend repeating the examination of peritoneal fluid early during treatment to assess the response and adjust empiric therapy accordingly. To evaluate the efficacy of response-guided empiric therapy, investigators randomized 261 patients with SBP (75% male; median age, 56; 15% with hepatocellular cancer) to cefotaxime, ceftriaxone, or ciprofloxacin. All participants underwent paracentesis at 48 hours to permit broadening of the antibiotic spectrum in the absence of an initial response (defined as >25% decline in polymorphonuclear cell count).
SBP resolution at…