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Trimethoprim-Sulfamethoxazole Prophylaxis of Spontaneous Bacterial Peritonitis
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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.
Nina Singh, MD
Victor L. Yu, MD
Veterans Affairs Medical Center; Pittsburgh, PA 15240
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
