1000research.3447.r4389

Referee response for version 1

Merli

Manuela

1

Referee

Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy

**Competing interests:**No competing interests were disclosed.

8

4

2014

Version 1

This is a retrospective study aimed at evaluating the relationship between dosing of ceftriaxone (1 or 2 grams) and outcome in SBP.

This issue is certainly of interest however, as the authors stated in the discussion, the study is inconclusive due to several limitations which derive from the retrospective approach. For this reason I would also suggest that the title should be changed to underline the point that the main finding in the study is that uneventfully these patients may receive different antibiotic dosages for the same indication. A possible title could be " *Need for antibiotic stewardship and treatment standardization in the care of cirrhotic patients*"

The answer to the question " *should we use 1 or 2g ceftriaxone*?" can only be derived from a prospective randomized study. On the other hand it is unlikely that one year mortality (Figure 1) could have been influenced by the treatment of the index episode. In fact these patients had a similar length of stay, a similar in hospital mortality and a similar rate of 30 days readmission. From this point of view, one could even derive that the therapy with 1g ceftriaxone was not inferior to 2g ceftriaxone. I suggest these observations be taken into account in the text.

I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Tapper

Elliot

Department of Medicine, Beth Israel Deaconess Medical Center, USA

**Competing interests:**No competing interests were disclosed.

18

6

2014

The reviewers' points are well taken and have been adopted in the manuscript. Language reinforcing the statistically equal efficacy of ceftriaxone doses has been inserted at critical point