Enhanced Spontaneous Bacterial Peritonitis Management in Cirrhosis: Peritoneal Lavage with Targeted Antibiotic

Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis, associated with high mortality and poor prognosis. This study aimed to evaluate the efficacy of a combined therapeutic approach-peritoneal catheter lavage, intraperitoneal antibiotic injection, and oral rifaximin-on top of standard intravenous antibiotics for SBP in cirrhotic patients. A total of 90 cirrhotic patients with SBP were randomly assigned to either the treatment group (n=45) or the control group (n=45). Both groups received basic care including hepatoprotective therapy, albumin supplementation, and electrolyte correction. The control group was treated with intravenous ceftriaxone (2 g/day for 14 days), while the treatment group was added peritoneal lavage (daily cycles of draining ascites, infusing warm saline, and injecting intraperitoneal ceftriaxone) plus oral rifaximin (200 mg three times daily) to the same intravenous regimen. Baseline characteristics, including demographic data, cirrhosis severity (Child-Pugh grade), and comorbidities, were comparable between the two groups (all P>0.05). After 14 days of treatment, the treatment group showed significantly greater improvements in clinical symptoms (fever, abdominal pain, tenderness) and laboratory markers: liver function parameters (ALT, AST, TBil) decreased more markedly, and inflammatory indicators (WBC, CRP, PCT) were reduced to a larger extent compared to the control group (all P<0.05). Notably, the ascitic fluid polymorphonuclear leukocyte count, a key marker of SBP resolution, dropped from 1200±350×10⁶/L to 150±50×10⁶/L in the treatment group, versus 1180±320×10⁶/L to 450±120×10⁶/L in the control group (P<0.001). The total effective rate was significantly higher in the treatment group (88.9%) than in the control group (62.3%, P<0.01). These findings suggest that combining peritoneal lavage, intraperitoneal antibiotics, and oral rifaximin with standard intravenous therapy enhances SBP control, improves liver function, and reduces systemic inflammation in cirrhotic patients, thereby offering a more effective strategy for managing this life-threatening complication.