Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis(SBP)

Spontaneous bacterial peritonitis is an acute bacterial infection of ascitic fluid in the absence of a contagious cause of infection (e.g., intestinal perforation or abscess).

Clinical presentation

• Fever and chills

• Abdominal pain or discomfort

• Worsening or unexplained encephalopathy

• Diarrhea

Investigations

• Ascites that does not improve following administration of diuretic medication

• Worsening or new-onset renal failure

• Ileus

Diagnosis

Diagnosis of spontaneous bacterial peritonitis is based on the demonstration of an absolute number of polymorphonuclear cells in ascitic fluid equal to or greater than 250/mm³.

Pharmacological treatment

Community-acquired spontaneous bacterial peritonitis

• Ceftriaxone (IV) 1 g 12–24 hourly for 5–10 days

  
  

  OR

• Amoxicillin-clavulanic acid (FDC) (IV) 1–2 g 6–8 hourly for 5–10 days

  
  

  OR

• Ciprofloxacin (IV) 200 mg 12 hourly for 5–10 days

AND

• Administration of albumin: dose is 1.5 g/kg on day 1 and 1 g/kg on day 3

Nosocomial spontaneous bacterial peritonitis treatment

• Meropenem (IV) 1 g 8 hourly for 5–7 days

Spontaneous bacterial peritonitis prophylaxis

Prophylaxis should be continuous until the disappearance of ascites (e.g., patients with alcoholic hepatitis), death, or transplant.

• Ciprofloxacin (PO) 400 mg 24 hourly for 10–14 days

  
  

  OR

• Co-trimoxazole (PO) 960 mg 24 hourly for 10–14 days