BACKGROUND & AIMS\nTreatment of spontaneous bacterial peritonitis currently involves intravenous antibiotic administration. To test the possibility of treating spontaneous bacterial peritonitis with oral antibiotics, oral ofloxacin was compared with intravenous cefotaxime in this infection.\n\n\nMETHODS\nOne hundred twenty-three cirrhotics with uncomplicated spontaneous bacterial peritonitis (no septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus) were randomly given oral ofloxacin (64 patients) or intravenous cefotaxime (59 patients).\n\n\nRESULTS\nInfection resolution rate was 84% in the ofloxacin group and 85% in the cefotaxime group. Peak serum levels and trough serum and ascitic fluid levels of ofloxacin and cefotaxime measured on days 3 (23 patients) and 6 (11 patients) of therapy were greater than the minimal inhibitory concentration of isolated organisms. Hospital survival rate was 81% in each group of patients. Blood urea nitrogen and hepatic encephalopathy at diagnosis were associated with prognosis. None of the 36 nonazotemic patients with community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy developed complications during hospitalization, and all were alive at time of discharge.\n\n\nCONCLUSIONS\nOral ofloxacin is as effective as intravenous cefotaxime in uncomplicated spontaneous bacterial peritonitis. Nonazotemic cirrhotic patients with uncomplicated community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy have an excellent prognosis and may be treated with oral ofloxacin without requiring hospitalization.

Randomized comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis

Background: Spontaneous bacterial peritonitis is one of the most frequent and serious complication in patients with liver cirrhosis and ascites associated with high mortality. Empiric antibiotic therapy should be initiated before the results of ascitic fluid cultures are available, guided by knowledge of the microbial spectrum of spontaneous bacterial peritonitis in a particular population. Methods: This is a descriptive study which was carried out in the Department of Gastroenterology and Hepatology, Postgraduate Medical Institute Hayatabad Medical Complex, Peshawar from January 2007 to December 2007. Fifty consecutive patients of established cirrhosis liver with ascites presenting with suspicion and or risk factors for spontaneous bacterial peritonitis were included in the study after informed consent. All selected patients were subjected to ascitic fluid tap. Twenty ml of ascitic fluid was aspirated in a heparinised disposable syringe; out of it 10 ml was immediately inoculated into blood culture bottle at bedside and sent for bacterial culture along with the remaining 10 ml for routine biochemical and cytological examination. Results: Out of 50 patients, 28 (56%) were diagnosed to have spontaneous bacterial peritonitis or its variants. Classic spontaneous bacterial peritonitis was present in 11 patients (39.28%), 16 (57.14%) patients were found to have culture negative neutrocytic ascites and one patient (3.57%) had bacterascites. Out of 28 cases of spontaneous bacterial peritonitis 12 samples of ascitic fluid showed positive culture reports. E. coli was the most frequently cultured organism isolated in 8 (66.66%) cases, Streptococcus pneumonae in 2 patients (16.66%), Staphylococcus aurus and Klebsiella each in 1 case (8.33%). Conclusion: Spontaneous bacterial peritonitis and its variants is a common complication of liver cirrhosis with ascites. E. coli is the most frequent offending organism in these cases. Knowledge of the microbial spectrum of spontaneous bacterial peritonitis in a particular population is important for the selection of the most appropriate empiric antibiotic regimen. Keywords: Cirrhosis liver, Spontaneous bacterial peritonitis, Ascitic fluid culture

Frequency of microbial spectrum of spontaneous bacterial peritonitis in established cirrhosis liver

OBJECTIVE To determine the prevalence of diabetic foot syndrome in type 2 diabetes mellitus patients. METHODS This cross-sectional study was conducted at 25 centres across eight cities in Pakistan from August 2010 to March 2011, and comprised adult type 2 diabetics. The subjects underwent ankle brachial pressure index evaluation for diabetic foot, and neurological assessment using 10g monofilament for sensation and 128Hz tuning fork to elicit vibration. RESULTS Of the 230 subjects, 94(40.86%) were males and 136(59.13%) females. The overall mean age was 53.82±9.96 years and mean glycated haemoglobin was 8.81±2.04%. The prevalence of diabetic foot syndrome was 32(13.9%). Based on established diabetic foot risk classification, 37(16.08%) patients were in category-1, 6(2.60%) in category-2, 32(13.91%) in category-3 and 148(64.34%) in category-0. On ankle brachial pressure index assessment, 94(40.86%) patients had impaired values (p<0.9). Sensation was impaired in 50(21.73%) patients, vibrations could not be detected in 37(16.08%), ankle reflexes could not be elicited in 35(15.21%), and foot pulses could not palpated in 28(12.17%) patients. CONCLUSIONS A high prevalence of diabetic foot syndrome was observed.

Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings.

OBJECTIVE To determine the frequency and compare the culture yield of bacterial isolation by conventional and blood culture BACTEC bottle techniques in cirrhotic patients with spontaneous bacterial peritonitis (SBP). STUDY DESIGN Cross-sectional comparative study. PLACE AND DURATION OF STUDY Pathology Department, Bannu Medical College, Bannu, KPK, from January 2012 to December 2013. METHODOLOGY Paracentesis of 20 ml of ascitic fluid tapped from cirrhotic patients with SBPwas carried out by a single technologist. The analysis included differential leukocyte count (DLC), while 5 ml each of the fluid was inoculated into conventional culture media and BACTEC blood culture bottle. All the data were analysed on (SPSS) version 16 to determine frequencies with percentages and mean values with standard deviation. Chi-square test was used for comparing the yield of conventional and blood culture bottle methods. P-value was considered significant if < 0.05. RESULTS In 105 cases of ascitic fluid analyses, 27 (25.72%) had positive ascitic fluid culture whereas 78 (74.28%) had negative ascitic fluid culture. Ascitic fluid culture was positive in 6 cases by conventional culture media and in 27 cases by BACTEC culture bottle media (p < 0.001). Bacterial isolation was obtained by both culture methods in 6 cases (p < 0.001). CONCLUSION Direct bedside inoculation of ascitic fluid by BACTEC culture bottle method has better yield as compared to conventional culture method.

Ascitic Fluid Culture in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Pharmaceutics, Bio Pharmaceutics and Pharmacokinetics, Novel Drug Delivery System, Pharmaceutical chemistry including medicinal and analytical chemistry; Pharmacognosy including herbal products standardization and Phytochemistry; Pharmacology, Bio Technology: Allied sciences including drug regulatory affairs, Pharmaceutical Marketing, Pharmaceutical Microbiology, Pharmaceutical biochemistry, Pharmaceutical Education and Hospital Pharmacy.Â

Indo american journal of pharmaceutical sciences

Objectives: To find out the relative frequencies of various etiologic pathogens and their sensitivity pattern in ascitic fluid of cirrhotic patients with spontaneous backrid patients. Material and Methods: This prospective observational study was conducted at Lady Reading Hospital Peshawar from July 2004 to April 2005 on 50 patients with established diagnosis of cirrhosis liver with possible diagnosis of spontaneous bacterial peritonitis (SBP). A questionnaire was designed comprising detailed history, general physical examination, history of alcoholism, history of upper GI bleed and features suggestive of SBP. Results: Study included 50 patients (30 male and 20 female) ranging in age from 18-72 years with mean age of 47.02+13.43 years. Ascitic fluid culture was positive by blood culture bottle method (BCBM) in 42(84%) cases. The relative frequencies of classical SBP, bacter-ascites (BA) and culture negative neutrocytic ascites (CNNA) by the BCBM were 36 (72%), 06 (12%) and 08 (16%) respectively. Gram negative enterobacteria were detected by BCBM in 30 (60%) cases. E. coli was the commonest organism isolated in 15 cases (30%) followed by Klebsiella pneumonia in 7 cases (14%). All gram negative organisms showed good sensitivity for quinolone, cefotaxime and ceftriaxone. Gram positive bacteria were isolated from 12 (24%) cases by BCBM with Streptococcus pneumonia as the commonest organism from 8 (16%) patients. Gram positive isolates showed good sensitivity to amoxicillin-clavulanic acid, cefotaxime and ceftriaxone. Conclusion: Bedside inoculation of the ascitic fluid in blood culture bottles results in earlier growth detection and subsequent start of specific antibiotic therapy which is the main goal of SBP treatment.

Causative organisms and their drug sensitivity pattern in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis

Objective: To find out the relative frequencies of various risk factors associated with Diabetic foot.

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Risk factors stratification in 100 patients with diabetic foot

Spontaneous Bacterial Peritonitis (SBP), a known complication of cirrhosis Liver is an acute bacterial infection of the peritoneum. Usually no source of infection is easily identifiable.
Objective:
To compare the efficacy of Ciprofloxacin and Cefotaxime in Cirrhosis Liver patients with SBP.
Material and Methods: This prospective, comparative, single center study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar from 1st October 2017 to 31st December 2018. A total of 300 admitted patients having Cirrhosis Liver with SBP were included in this study. The patients were randomized into Group A and Group B. Group A was treated with Intravenous Ciprofloxacin and Group B was treated with Intravenous Cefotaxime given twice daily for a period of 5 days. Diagnostic peritoneal paracentesis was done before the start of the treatment and repeated after 5 days therapy. Patients who were either non cirrhotic or had secondary bacterial peritonitis were excluded from the study.
Results: A total of 300 Cirrhosis Liver patients with SBP were studied in two equal randomized groups. Out of these 168 were male and 132 were female. The mean age of patients in study was 51.14±11.9 years. The age ranged between 15-75 years. In Group A, 82 percent responded to ciprofloxacin and in group B, 86 percent responded to cefotaxime.
Conclusion:
Both intravenous ciprofloxacin and cefotaxime are effective in treating spontaneous bacterial peritonitis in patients with Cirrhosis Liver.
Key Words: Ciprofloxacin, Cefotaxime, Spontaneous bacterial peritonitis, Efficacy.

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The EFFICACY OF CIPROFLOXACIN AND CEFOTAXIME IN PATIENTS WITH CIRRHOSIS LIVER PRESENTING WITH SPONTANEOUS BACTERIAL PERITONITIS TO A TERTIARY CARE HOSPITAL

Background: Urinary tract infection (UTI) is one of the most common bacterial illnesses in adults and is one of the most common indications for antibiotics. This study is conducted to determine frequency of E-Coli and its sensitivity to nitrofurantoin in patients with urinary tract infection.
Materials and Methods: The study was conducted at a tertiary care hospital of District Peshawar, i.e. Khyber Teaching Hospital (KTH), after reviewed and approved by the Committee for Ethical Review of Research involving Human Subjects of KTH. Non-random consecutive sampling technique was used for the collection of data and data collection was completed in 06 months’ time i.e. from 20th February to 19th August 2018. The survey was conducted as a descriptive cross-sectional study using open Epi calculator, keeping confidence interval of 95%, sample size calculated is 148. Urine samples were collected in sterile containers and was sent to laboratory for routine examination, culture and sensitivity. A colony 105 or more was considered E Coli growth. Nitrofurantoin was used to check the sensitivity for organisms as per operational definition. All the tests and examinations were carried out under the supervision of experienced medical specialist and microbiologist.
RESULTS: In this study, 148 patients were studied. Average age was 41.86 years + 11.62SD. E coli was found in 91(61.5%) of patients out of total 148 patients. Among UTI patients 78(85.7%) were sensitive to Nitrofurantoin.
CONCLUSION: High prevalence of drug-resistant urinary tract pathogens, particularly to Nitrofurantoin suggests cautious use of antibiotic therapy for the treatment of UTI

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Ahmar Rashid

Papers

Causative organisms and their drug sensitivity pattern in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis

Risk factors stratification in 100 patients with diabetic foot

The EFFICACY OF CIPROFLOXACIN AND CEFOTAXIME IN PATIENTS WITH CIRRHOSIS LIVER PRESENTING WITH SPONTANEOUS BACTERIAL PERITONITIS TO A TERTIARY CARE HOSPITAL

Frequency of E coli and its sensitivity to nitrofurantion in patients with urinary tract infection