REPLY
Trimethoprim-Sulfamethoxazole Prophylaxis of Spontaneous Bacterial Peritonitis
Nina Singh, MD, and
Victor L. Yu, MD
15 November 1995 | Volume 123 Issue 10 | Page 810
IN RESPONSE:
Dr. Nishioka states that three episodes of peritonitis in the control group could not have been prevented by trimethoprim-sulfamethoxazole. This is incorrect. Trimethoprim-sulfamethoxazole is active against Klebsiella pneumoniae with minimum inhibitory concentrations ranging from 0.05 to 3.1 µg/mL [1]. The isolate in the control patient with K. pneumoniae bacteremia was sensitive to trimethoprim-sulfamethoxazole, as are 83% of the K. pneumoniae isolates in our institution. Trimethoprim-sulfamethoxazole also has in vitro activity against enterococci [2]; however, the activity of the drug is inconsistent, and this agent cannot be recommended for treating serious enterococcal infections.
A history of spontaneous bacterial peritonitis represents one of several risk factors for peritonitis in patients with cirrhotic ascites. The number of patients with previous spontaneous bacterial peritonitis in our study, however, was too small (27% in the prophylactic group and 17% in the control group) to allow statistical analysis of infections in these patients alone.
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Author and Article Information
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Veterans Affairs Medical Center; Pittsburgh, PA 15240
1. Zinner SH, Mayer KH. Sulfonamides and trimethoprim. In: Mandell GL, Douglas RG, Bennett JE. Dolin R, eds. Principles and Practice of Infectious Diseases. New York: Churchill Livingstone; 1995:354-64.
2. Crider SR, Colby SD. Susceptibility of enterococci to trimethoprim and trimethoprim-sulfamethoxazole. Antimicrob Agents Chemother. 1985; 27:71-5.
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