ROSH Gastrointestinal Practice Exam

What is the most appropriate intravenous antibiotic for a patient with alcoholic cirrhosis presenting with fever and ascitic fluid indicating infection?

1. Ampicillin

2. Cefotaxime

3. Sulfamethoxazole/trimethoprim

4. Vancomycin

The correct answer is: Cefotaxime

Cefotaxime is the most appropriate intravenous antibiotic for a patient with alcoholic cirrhosis who presents with fever and ascitic fluid suggesting infection, particularly if there's a concern for spontaneous bacterial peritonitis (SBP). Patients with cirrhosis are at an increased risk for infections due to altered immune responses and potential bacterial translocation from the gut. Cefotaxime is a broad-spectrum cephalosporin antibiotic that is effective against common pathogens associated with SBP, particularly Escherichia coli and Klebsiella pneumoniae. It penetrates well into the ascitic fluid, making it especially suitable for treating infections in patients with ascites. The selection of cefotaxime aligns with evidence-based guidelines for treating SBP, which recommend it as a first-line therapy due to its efficacy and safety profile in this patient population. This antibiotic also has a good dosing regimen, which suits the acute setting often seen in cirrhosis patients. Other antibiotics listed have roles in treating different infections but do not match the specific clinical scenario as effectively as cefotaxime does. Ampicillin is less effective against the Gram-negative pathogens typical in SBP. Sulfamethoxazole/trimethoprim has limited