Spontaneous Bacterial Peritonitis

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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
  • Ascites that does not improve following administration of diuretic medication
  • Worsening or new-onset renal failure
  • Ileus

Investigations  

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 

B: ceftriaxone (IV) 1g 12-24 hourly for 5- 10days 

OR 

B: amoxicillin-clavulanic acid (FDC) (IV) 1-2g 6-8hours for 5-10days 

OR 

C: ciprofloxacin (IV) 200mg 12hourly for 5–10days 

AND  

S: administration of albumin dose is 1.5 g/kg on day 1 and 1 g/kg on day 3 

Nosocomial spontaneous bacterial peritonitis treatment 

S: meropenem (IV) 1gm 8hourly for 5-7days 

Spontaneous bacterial peritonitis prophylaxis 

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

A: ciprofloxacin (PO) 400mg 24hourly for 10-14days 

OR  

A: co-trimoxazole (PO) 960mg 24hourly for 10-14days