Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management

Ascites PMN > 250/mm3

? Nosocomial or hospital acquired. Recent exposure to antibiotics, Presentation in septic shock 

   yes → Broad-spectrum coverage (Piperacillin/Tazobactam)

   no → 3rd gen cephalosporine (ceftriaxone, cefotaxime)

SBP: Medical Management

Repeat tap:

  - 2 days after empirical antibiotic therapy to confirm response

  - ↓ PMN <25% from baseline indicates lack of response

Give IV albumin, especially in patients with AKI and/or jaundice.

Secondary prophylaxis - Best evidence: long-term prophylaxis with daily norfloxacin, Ciprofloxacin is acceptable

Upper Gl bleeding: Short-term (< 7 days) antibiotic (ceftriaxone 1g/24h) prophylaxis

Primary prophylaxis with ciprofloxacin may be considered if: Low protein (< 1.5g/L) ascites, Renal dysfunction or liver failure



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