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