摘要AIM:To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.METHODS:All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study.SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was＞250 cells/mm3,and empirically treated with cefotaxime.RESULTS:Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women;mean age:58.6±11.2 years).Prevalence of SBP,in our population,was 17%.Ascitic fluid culture was positive in nine (24%)cases only.Eleven episodes were nosocomial and 71%community-acquired.Treatment with cefotaxime was successful in 59% of cases,while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h.Change of antibiotic therapy led to the resolution of infection in 87% of episodes.Among the cases with positive culture,the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series.In these cases,the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.CONCLUSIOM:In clinical practice,ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy.The initial treatment with cefotaxime failed more frequently than expected.An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding.A different first-line antibiotic treatment should be investigated.