Comparative outcomes of Piperacillin-Tazobactam versus Ceftriaxone in managing spontaneous bacterial peritonitis in cirrhotic patients: An observational study

Background: Spontaneous bacterial peritonitis (SBP), a serious complication of liver cirrhosis, demands prompt antibiotic treatment, but rising resistance to ceftriaxone has spurred interest in alternative therapies. Objective: To compare the treatment outcomes of Piperacillin-Tazobactam versus ceftriaxone in spontaneous bacterial peritonitis among cirrhotic patients. Methods: This comparative observational study was conducted from 1st January to 1st July 2023 at the Services Institute of Medical Sciences, Lahore, Pakistan. A total of 218 cirrhotic patients, 18-60 years of age, diagnosed with SBP based on an ascitic fluid polymorphonuclear (PMN) count >250/μL, were enrolled using non-probability consecutive sampling. On the physician’s discretion, patients receiving Piperacillin-Tazobactam (4.5 g IV every 8 hours) were allocated to Group A (n=109) and those receiving Ceftriaxone (2 g/day) were allocated to Group B (n=109). Treatment response was observed on day five by assessing clinical improvement and repeat ascitic fluid analysis. A Chi-square test was conducted using SPSS version 22 for statistical analysis. Results: The mean age of the study population was 35.7 ± 6.5 years, with 61.93% male patients. A higher proportion of patients treated with Piperacillin-Tazobactam (75.2%) showed resolution of SBP by day 5 compared to those receiving Ceftriaxone (62.4%). Although there was a difference in the response to the treatments (χ²=3.61, p=0.0574), it was statistically not significant. Across stratified subgroups, age, gender, symptom duration, Child-Pugh score, and PMN count for the Piperacillin-Tazobactam (group A) showed higher, though statistically insignificant, treatment response rates compared to Ceftriaxone (group B). Conclusion: Piperacillin-Tazobactam showed a higher, though statistically insignificant, resolution rate of SBP compared to Ceftriaxone. This trend was consistent across age groups, gender, symptom duration, Chil-Pugh score, and PMN count, suggesting a potential clinical advantage.