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Imipenem Versus Cefepime in Spontaneous Bacterial Peritonitis and to Evaluate the Risk Factors for Treatment Failure

I

Institute of Liver and Biliary Sciences, India

Status

Completed

Conditions

Spontaneous Bacterial Peritonitis

Treatments

Drug: cefepime + Albumin
Drug: Imipenem + Albumin

Study type

Interventional

Funder types

Other

Identifiers

NCT01852630
ILBS- SBP-01

Details and patient eligibility

About

  1. All consecutive patients with Cirrhosis and ascites admitted to ILBS (Institute of Liver & Biliary Sciences) will be evaluated for the presence of SBP (Spontaneous Bacterial Peritonitis) by ascitic fluid examination at admission.
  2. SBP (Spontaneous Bacterial Peritonitis) will be diagnosed in the presence of absolute neutrophil count (ANC >250/mm3) with/without positive ascitic fluid culture and Patients with SBP (Spontaneous Bacterial Peritonitis) included in the study will be randomized to receive cefepime or imipenem.
  3. However, other SBP (Spontaneous Bacterial Peritonitis) patients not included for randomization will be given empirical therapy with 3rd generation cephalosporin (ceftriaxone).

Full description

Baseline evaluation:

Baseline clinical, laboratory and disease severity parameters will be evaluated for each study patient.

  1. Etiology of cirrhosis.
  2. Severity of liver disease. CTP (Child-Turcotte-Pugh) score MELD (Model for End-stage Liver Disease) score MELD (Model for End-stage Liver Disease)-Na score IMSAA score
  3. Decompensations/complications of CLD (Chronic Liver Disease) UGI bleed, Hepatic encephalopathy, AKI (Acute Kidney Injury) etc.
  4. Laboratory investigations:

Serum electrolytes Liver function tests Kidney function tests Pro calcitonin USG/CT abdomen Complete blood counts Coagulation parameters Ascitic fluid analysis- TLC, DLC, Protein, sugar, culture, SAAG. Chest X ray PA view HBsAg and Anti-HCV and other etiological workup as available.

Enrollment

175 patients

Sex

All

Ages

18 to 65 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Cirrhotic Patients with SBP (Spontaneous Bacterial Peritonitis) having any of the following risk factors would be considered as 'Difficult to Treat SBP' and would be included -
  1. Nosocomial SBP: occurence of SBP (Spontaneous Bacterial Peritonitis) after 48 hours of hospital admission, or
  2. Prior ascitic fluid infection with 3rd generation cephalosporin resistant organism, or
  3. No response to treatment with 3rd generation cephalosporins after 48 hours.

Exclusion criteria

  1. Age less than 18 years.
  2. Cirrhotics with SBP (Spontaneous Bacterial Peritonitis) managed as outpatients.
  3. Post liver transplant, HIV patients.
  4. Patients on systemic chemotherapy, immunosuppressant drugs.
  5. Growth of bacteria resistant to intervention drugs in ascitic fluid culture.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

175 participants in 2 patient groups

cefepime + Albumin
Experimental group
Description:
cefepime 1g iv 8 hourly + Albumin will be given for 2 days.
Treatment:
Drug: Imipenem + Albumin
Imipenem + Albumin
Active Comparator group
Description:
Imipenem 1g iv 8 hourly + Albumin will be given for 2 days.
Treatment:
Drug: cefepime + Albumin

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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