Active substances: Norfloxacin
Its development is based on the accumulation of scientific evidence, transparency and replicability of the method.
Its main goal is to achieve quality improvement in health care. The description of the evidence and recommendations should be accessible and concise, so that the information is quickly assimilated by the user.
In some cases, the use of algorithms can help the understanding and assimilation of the information provided. User satisfaction is the difference with a positive sign between the perceived quality and expectations on the service.
First, it has been shown that satisfaction is a good indicator of treatment compliance by patients, and adherence to consultation and service provider.
Secondly, satisfaction is a useful tool to assess the consultations and communication models, for example, success in informing and involving patients in decision making about the kind of attention that they need.
Cryptogenic cirrhosis cirrhosis without a recognised cause is nowadays rarely diagnosed, particularly after the identification of the hepatitis C virus in the late 1980 s and with the identification of nonalcoholic steatohepatitis in obese and diabetic subjects.
This syndrome correlates with bacterial infection at admission and has been shown to be associated with a poor outcome. However, cultures of small intestinal mucosal bacteria in cirrhotic patients have shown that these microbiota are qualitatively and quantitatively normal.
This has shifted attention towards factors that decrease gut integrity, or alter the removal of translocating bacteria as causative factors of bacteraemia in cirrhosis. This permeability is further increased in patients with portal hypertension.
Serum levels of interleukin-6 and soluble receptors of tumor necrosis factor were shown to be significantly higher in HIV-HCV co-infected and HCV mono-infected patients with decompensated cirrhosis when compared with those with compensated liver disease.
This was demonstrated when quantitative real-time polymerase chain reaction PCR using primers that amplify all known bacteria was used to measure bacteraemia following tooth-brushing. Translocation is only possible because of the concurrent failure of the defensive mechanisms in cirrhosis.
Research has confirmed an increased bacterial translocation in cirrhotic rats. There is also pronounced impairment of gastrointestinal tract motility in cirrhosis.
A disturbance of the gut microflora thus occurs and this, in association with changes in the permeability of the gastrointestinal tract, causes the passage of microorganisms and endotoxins to the mesenteric lymph nodes.
Half the episodes of SBP are present on hospital admission while the rest are acquired during hospitalization. Empirical antibiotics should be started immediately following the diagnosis of SBP.
The first line antibiotic treatment in SBP are the third generation cephalosporins, as the commonest causative organisms are Gram-negative aerobic bacteria.