الفهرس 
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Abstract
Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis. The prevalence of the condition in hospitalized cirrhotic patients with ascites ranges between 10 and 30% and the associated mortality is in the order of 25%. Patients with the greatest risk for the development of SBP are those who have recovered from a first episode. In these patients the recurrence rate is very hgh. Long-term oral antibiotics is recommended for such patients until resolution of ascites, transplantation or death. The aim of ths study is to compare the effectiveness of different regimens of oral antibiotics for prophylaxis of SBP in patients with cirrhosis and ascites who had at least one previous episode of SBP. In ths work, 180 cirrhotic patients with ascites with a previous hstory of at least one episode of SBP had different regimens of prophylactic antibiotics for 6 months. They were divided into 6 groups as follows group I: 30 patients received Ciprofloxacin (750 mg once weekly); group 11: 30 patients received Ciprofloxacin (750 mg twice weekly); group 111: 30 patients received Norfloxacin (400 mglday); group IV: 30 patients received Norfloxacin (400 mglweek); group V: 30 patients received Trimethoprim-sulfamethoxazole (1 8 0 mgl800 mglday for 5 dayslw eek); group VI : 3 0 patients received Trimethoprim-sulfamethoxazole (1 80 mgl80 0 mglw eek) Patients with a current SBP infection were excluded from ths study; based on clinical symptoms and signs (abdominal pain and increasing abdominal distension, fever, diarrhea and unexplained encephalopathy or renal dysfunction) and confirmed by neutrocytic ascites with polymorphonuclear cell count >250 cellslmm3 andlor positive ascitic fluid culture with or without neutrocytic ascites. Also, patients with hepatocellular carcinoma were excluded. All patients were subjected to full medical hstory taking, thorough clinical examination. Laboratory investigations were also done including complete blood picture, liver profile, kidney fbnctions, hepatitis viral markers (HBsAg, HCV-Ab) as well as radiological examination in the form of abdominal ultrasonography. All patients were followed up for 6 months to detect the effect of these different regimens in prophylaxis against SBP. The rate of SBP relapse at the end of follow up period in group 1 was lo%, in group 2 was lo%, in group 3 was 6.7%, in group 4 was lo%, in group 5 was 6.7% and in group 6 was 13.3%. These rates are less than those mentioned in the literature for cirrhotic ascetic patients receiving no antibiotic prophylactic therapy. Each antibiotic used in the current shtdy was tried in 2 doses [ciprofloxacin (750 mg once weekly and 750 mg twice weekly); norfloxacin (400 mglday and 400 mglweek) trimethoprim-sulfamethoxazole (1 80 mgl80O mglday for 5 dayslweek and 180 mgl800 mglweek)]. Comparison of different doses of each antibiotic used was comparable where there was no significant difference was obtained. Also, comparison between ciprofloxacin & norfloxacin; ciprofloxacin & trimethoprim-sulfamethoxazole, and norfloxacin & trimethoprim-sulfamethoxazole showed comparable results regarding the rate of SBP relapse at the end of 6 months follow up period. The rate of SBP relapse in the studied antibiotic prophylaxis patients according to Chld-Pugh score showed was no sigmficant difference in the rate of relapse between Chld B and Chld C patients. The rate of renal impairment among studied patients was 10% whch is less than rates mentioned in literature for placebo groups. Side effects of treatment in the studied patients were nausea andlor vomiting that was noted in trimethoprim-sulfamethoxazone (1 80 mgl8OO mglday for 5 dayslweek group (26.7%); oral candidiasis was noted in Ciprofloxacin (750 mg twice weekly) group (lo%), neutropenia was noted in group norfloxacin (400 mg once weekly) group (23.3%), pruritis in group trimethoprim-sulfamethoxazone (180 mgl800 mglday for 5 dayslweek) group (16.7%), erythema in norfloxacin (400 mg once weekly) group (16.7%) and hypersomnia in norfloxacin (400 mg once weekly) group (10%). In conclusion, the current study showed that antibiotics used (ciprofloxacin, norfloxacin and trimethoprim-sulfamethoxasone) showed comparable results in prevention of recurrence of SBP with no serious side effects. All regimens used in ths work showed comparable effectiveness and adverse effects, so the choice of such regimens should depend on the cost effectiveness and patients’ tolerability. It has been shown also in the current shtdy that antibiotic prophylaxis not only prevents bacterial infections but also decreases incidence of renal impairment and improves survival.