الفهرس 
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Abstract
Patients with cirrhosis have an increased risk of developing bacterial infections and sepsis, compared to the general population, and bacterial infection has been associated with a 4‐fold increase in mortality risk in patients with cirrhosis. Among infections, spontaneous bacterial peritonitis (SBP) is one of the most frequent, life‐threatening in these patients. SBP is defined as a bacterial infection of ascitic fluid developed in patients without any intra-abdominal, surgically treatable source of infection. The recurrence of SBP after treating the condition occurs in a high percentage of cirrhotic patients if no prophylactic measures are taken, reaching up to 70%at 1-year after the first episode. Secondary prophylaxis against SBP is warranted in patients having a history of previous SBP to prevent recurrence. Several drugs are used in the prophylaxis as ciprofloxacin, norfloxacin, The aim of this study is to compare between Norfloxacin, Nitazoxanide and Colistin as secondary prophylaxis for Spontaneous Bacterial Peritonitis. Our study included 90 cirrhotic ascitic patients who were admitted to Tropical Medicine Department, Tanta University Hospital suffering from spontaneous bacterial peritonitis and cured after taking the recommended treatment for spontaneous bacterial peritonitis. Patients were then randomized into three groups, group 1: 30 cirrhotic ascitic patients whom cured from spontaneous bacterial peritonitis and received 400 mg norfloxacin daily once, group 2: 30 cirrhotic ascitic patients whom cured from spontaneous bacterial peritonitis and received 500 mg nitazoxanide twice daily, group III: 30 cirrhotic ascitic patients whom cured from spontaneous bacterial peritonitis and received colistin syrup 15 ml three times daily (2.25 MIU daily). The patients were subjected to full history taking, complete clinical exam, complete blood count (Hemoglobin, WBCs and platelet count), C – reactive protein , Erythrocyte sedimentation rate ,blood urea and creatinine, liver function tests (total bilirubin, serum ALT, serum AST, serum albumin and prothrombin time and activity), viral markers (HCV Abs, HB sAg, HIV Abs), pelvi-abdominal ultrasound and diagnostic abdominal paracentesis (including ascitic fluid protein, ascitic fluid sugar ,ascitic fluid total leukocytic count and ascetic neutrophil count) at admission to the hospital, at discharge, 2 months and 6 months after discharge . Culture and sensitivity of the ascetic fluid was done for patients with recurrent SBP to detect causative organism. Our results showed that; In the present study, there was an insignificant difference between the three groups as regards age and sex as p =0.159, 0.853, also there was no significant difference between the studied groups regarding hypertension or diabetes mellitus. Similarly, there was no significant difference between the studied groups regarding laboratory investigations as CBC, liver functions and renal functions (p > 0.05). Regarding ascitic fluid analysis there was also nonsignificant difference between the three groups at admission, 2 months and 6 months after discharge as regard protein, (p at admission = 0.536, p at 2 months = 0.138, p at 6 months = 0.580), regarding within-group comparisons across the time points, the three studied groups had a significantly higher mean ascitic protein levels at (discharge, 2ms after discharge and 6 ms after discharge) compared to that at admission. Glucose (p at admission =0.919, p at 2 months = 0.971, p at 6 months = 0.745). Regarding TLC (p at admission = 0.156, p at 2 months = 0.183, p at 6 months = 0.109) and PMN (p at admission = 0.289, p at 2 months = 0.463, p at 6 months = 0.368). Regarding Child-Pugh’s classification, and ultrasound findings (liver, spleen and ascites) statistically nonsignificant difference was found among the groups (p for Child-Pugh’s at admission =0.551, p at 2 months = 0.527, p at 6 months = 0.510) (p for liver =0.232, p for spleen = 0.484 and p for ascites = 0.244). Our results showed that recurrent SBP was recorded in 8 patients out of the studied 90 patients (3 in norfloxacin group, 3 in nitazoxanide group, and 2 in colistin group). Regarding the norfloxacin group, E-coli was isolated in 2 patients and Streptococcus in one patient. In the nitazoxanide group, E-coli was detected also in 2 patients but Klebsiella in one patient. As for the colistin group, E-coli and Streptococcus were isolated in one patient each. No significant association was detected between the treatment group and the type of isolated organism (p = 0.547).