***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Oral ciprofloxacin has been shown to be effective in the treatment of infections due to gram-positive cocci and gram-negative rods . The efficacy and safety of intravenous ciprofloxacin was compared with that of intravenous ceftazidime in the treatment of 59 patients with well-documented serious infections in a prospect i ve , controlled , r and omized study with a third-party blinding . Thirty-three patients were treated with intravenous ciprofloxacin  ( 200 mg every 12 hours , plus a daily extra placebo dose ) ; 26 patients were treated with ceftazidime  ( 1 g every eight hours ) . The severity of the infections , underlying diseases , and demographic features were comparable in both groups , although there were more men in the ciprofloxacin group . For ciprofloxacin/ceftazidime treatments , respectively , the evaluated infections were : pyelonephritis ( 16 patients /nine patients ) , pneumonia ( three/five ) , soft-tissue infections ( four/zero ) , spontaneous peritonitis ( five/two ) , primary bacteremia ( three/eight ) , and other ( two/two ) . Isolated pathogens included : Escherichia coli ( 22/12 ) , Klebsiella sp. ( five/four ) , Pseudomonas aeruginosa ( two/three ) , Haemophilus influenzae ( one/one ) , Proteus mirabilis ( two/zero ) , Proteus vulgaris ( one/zero ) , Salmonella sp. ( zero/two ) , Plesiomonas shigelloides ( one/zero ) , and others ( one/four ) . The clinical responses were cure or improvement in 31 ciprofloxacin cases/21 ceftazidime cases ; failure , zero/four ; and indeterminate , two/one . The bacteriologic responses were eradication in 28 ciprofloxacin cases/22 ceftazidime cases ; persistence , one/three ; and indeterminate , four/one . Mild intolerance occurred in three ciprofloxacin cases and two ceftazidime cases . A mild increase in serum hepatic enzymes was observed in two patients in each group . Superinfections occurred in five patients : enterococcal septicemia ( zero/two ) and urinary tract infections ( one/two ) . The results presented suggest that intravenous ciprofloxacin is an effective and safe antimicrobial agent for the treatment of serious infections , with an efficacy comparable with that of ceftazidime , a broad-spectrum cephalosporin . An additional advantage seems to be a lower rate of superinfections OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials BACKGROUND / AIMS Cefotaxime or ceftriaxone were considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing spontaneous bacterial peritonitis . It has been suggested that ciprofloxacin could be an alternative to cefotaxime or ceftriaxone in cirrhotic patients developing spontaneous bacterial peritonitis . The aim of the present study was to compare oral ciprofloxacin with cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis in cirrhotic patients . METHODOLOGY Fifty-three hospitalized cirrhotic patients with spontaneous bacterial peritonitis were prospect ively included and r and omized into three groups : group A ( n = 16 ) ; received orally 500 mg ciprofloxacin every 12 h , group B ( n = 18 ) ; received intravenous cefotaxime 2 g every 8 h and group C ( n = 19 ) received intravenous ceftriaxone 2 g every 24 h. RESULTS 15 patients from the ciprofloxacin group , 17 from the cefotaxime group and 17 patients from the ceftriaxone group were finally analyzed . Spontaneous bacterial peritonitis resolution in three groups was found to be 80 % , 76 % , and 83 % , respectively ( p = NS ) . Incidence of complications and hospital mortality was similar in the three groups . No adverse events were observed in any of the three groups . The cost of the treatment was statistically lower in the ciprofloxacin group than in the cefotaxime group and ceftriaxone group ( p < 0.001 ) . CONCLUSIONS These results suggest that orally ciprofloxacin is as effective as cefotaxime and ceftriaxone in the empirical treatment of spontaneous bacterial peritonitis in cirrhotic patients , and is also less expensive and can be administered orally In order to identify the predictive factors of hospital mortality in cirrhotics with spontaneous bacterial peritonitis ( SBP ) , we studied 64 patients who fulfilled the accepted diagnostic criteria . All cases were treated with cefotaxime up to 2 days after the infection was considered cured ( 7.7 + /- 2.9 days ) . Eleven patients ( 17 % ) died while in hospital , six of them before SBP was cured . After uni- and multivariate analyses , only seven routine clinical , biological , and bacteriological variables studied were independently associated with hospital mortality . These were : the presence of upper gastrointestinal bleeding at admission ( beta = 2.01 ) , the absence of abdominal pain as presenting symptom ( beta = -1.29 ) , the polymorphonuclear count ( % ) in the ascites ( beta = 0.48 ) , prothrombin rate ( beta = -0.22 ) , and serum Na ( beta = -0.64 ) , creatinine ( beta = 0.50 ) , and cholesterol ( beta = -0.68 ) . When the equation obtained was computed in a r and omly selected sample of the patients studied , it correctly predicted the outcome in 92.3 % of the cases . We conclude that short-term outcome of SBP patients depends on the existence of recent gastrointestinal bleeding , the severity of SBP , and the degree of liver and renal failure . The prognostic value of this model needs prospect i ve validation in a new series of patients The aim of the study was to investigate the prevalence and clinical course of renal failure that was induced by the various types of bacterial infections in patients with cirrhosis and ascites . Three hundred and nine patients , who were consecutively admitted to the 3 major hospitals of Padova , Italy , during the first 6 months of 2005 , were studied prospect ively . Of these , 233 patients ( 75.4 % ) had evidence of ascites . In 104 patients with cirrhosis and ascites ( 44.6 % ) a bacterial infection was diagnosed . A bacterial infection‐induced renal failure was observed in 35 of 104 patients ( 33.6 % ) . The prevalence of renal failure was higher in biliary or gastrointestinal tract infections and in spontaneous bacterial peritonitis ( SBP ) and in than in other types of infections . In addition , the progressive form of renal failure was only precipitated by biliary or gastrointestinal tract infections , SBP , and urinary tract infections ( UTI ) . In a multivariate analysis only MELD score ( P = 0.001 ) , the peak count of neutrophil leukocyte in blood ( P = 0.04 ) , and the lack of resolution of infection ( P = 0.03 ) had an independent predictive value on the occurrence of renal failure . Conclusion : The results of the study show that the development of bacterial‐induced renal failure in patients with cirrhosis and ascites is related to the MELD score , and to both the severity and the lack of resolution of the infection . A progressive form of renal failure occurs only as a consequence of biliary or gastrointestinal tract infections , SBP , and UTI . ( HEPATOLOGY 2007;45:223–229 . The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis . We conducted a prospect i ve evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000 . A total of 405 patients presented 572 bacterial infections in 507 admissions .  Spontaneous bacterial peritonitis was the most frequent infection ( 138 cases ) . Gram-positive cocci were responsible for 53 % of total bacterial infections in the study , being the main bacteria isolated in nosocomial infections ( 59 % ) . Patients requiring treatment in an intensive care unit and those su bmi tted to invasive procedures presented a higher rate of infections caused by gram-positive cocci ( 77 % vs. 48 % , P < .001 and 58 % vs. 40 % , P < .02 , respectively ) . Fifty percent of culture-positive spontaneous bacterial peritonitis in patients on long-term norfloxacin administration ( n = 93 ) and 16 % in patients not receiving this therapy ( n = 414 ) were caused by quinolone-resistant gram-negative bacilli , P = .01 . The rate of culture-positive spontaneous bacterial peritonitis caused by  trimethoprim-sulfamethoxazole-resistant  gram-negative bacilli was also very high in patients on long-term norfloxacin administration ( 44 % vs. 18 % , P = .09 ) . In conclusion , infections caused by gram-positive cocci have markedly increased in cirrhosis . This phenomenon may be related to the current high degree of instrumentation of cirrhotic patients . Quinolone-resistant spontaneous bacterial peritonitis constitutes an emergent problem in patients on long-term norfloxacin prophylaxis , with trimethoprim-sulfamethoxazole not being a valid alternative We compared the effectiveness and incidence of nephrotoxicity of ampicillin-tobramycin and cefotaxime in 73 cirrhotics who had severe bacterial infection . Most of these patients had spontaneous peritonitis and /or bacteremia . Patients were r and omly allocated into two groups . Group I included 36 patients treated with ampicillin-tobramycin and Group II comprised 37 patients treated with cefotaxime . Patients from both groups were similar with respect to clinical data , st and ard liver and renal function tests , types of infection and isolated organisms . Ninety-two per cent of bacteria isolated in Group I and 98 % of those isolated in Group II were susceptible in vitro to ampicillin-tobramycin and to cefotaxime , respectively . Ampicillin-tobramycin  cured the infection in 56 % of Group I patients , and cefotaxime in 85 % of Group II patients ( p less than 0.02 ) . Five patients treated with ampicillin-tobramycin , and none treated with cefotaxime developed superinfections ( p = 0.024 ) . Nephrotoxicity ( impairment of renal function associated with an increase of urinary beta 2-microglobulin to over 2,000 micrograms per liter ) occurred in two patients in Group I and none in Group II . These results suggest that broad-spectrum cephalosporins should be considered as first choice antibiotics in cirrhotic patients with severe infections BACKGROUND AND AIM Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic patients on large-volume paracentesis  is unknown . The aim of this study was to investigate spontaneous bacterial peritonitis and bacterascites prevalence in a prospect i ve cohort of cirrhotic out patients following large-volume paracentesis with low risk of infection . METHODS We 
    Output:
    
Currently , the evidence showing that lower dosage or short-term treatment with third generation cephalosporins is as effective as higher dosage or long-term treatment is weak .
This review provides no clear evidence for the treatment of cirrhotic patients with spontaneous bacterial peritonitis .