16 一位63歲女性肝硬化病人因大量腹水住院治療，理學檢查發現有flapping tremor現象，腹水檢查發現多核性白血球＞250/mm3，下列何項治療最不適當？

 口服lactulose 利尿劑併albumin治療

靜脈注射aminoglycoside 靜脈注射第二代cephalosporin

NO AMINOGLYCOSIDE ALONE

RULE OF THUMB IS TO GIVE EMPIRIC ANTIBIOTICS WITH BROAD SPECTRUM!

Antimicrobials

Traditionally, a combination of an aminoglycoside and ampicillin was used to treat spontaneous bacterial peritonitis. This regimen affords excellent empiric coverage of more than 90% of cases of spontaneous bacterial peritonitis caused by gram-negative aerobes or gram-positive cocci. More recently, the third-generation cephalosporin cefotaxime has been demonstrated to be as efficacious as the ampicillin/aminoglycoside combination, and it does not carry the increased risk of nephrotoxicity in cirrhotic patients. Cefotaxime does not cover enterococci (up to 5% of cases)