Spontaneous bacterial peritonitis

First Line

Co-amoxiclav 1.2g IV 8 hrly

 

Penicillin Allergy

Vancomycin IV as per protocol AND Ciprofloxacin 400mg IV 12 hrly AND Metronidazole 500mg IV 8hrly 

If on ciprofloxacin as prophylaxis

Vancomycin IV as per protocol AND Gentamicin IV as per protocol AND Metronidazole 500mg IV 8hrly 

Prophylaxis of SBP

Should be given to all patients with a history of previous SBP and those with a confirmed ascitic protein content <15g/l

CHECK PREVIOUS SENSITIVITIES OF ASCITIC FLUID CULTURES TO INFORM CHOICE

First line:

Co-trimoxazole 960mg once daily (eGFR>30ml/min) or 480mg once daily (eGFR< 30ml/min) PO

Co-trimoxazole allergic patient or second line:

Ciprofloxacin 750mg weekly PO

 

 

Notes

Defined clinically as ascitic polymorph count >250 cells mm3

Give antibiotics in conjunction with intravenous albumin (20%): 1.5g/kg on day 1, then 1.0g/kg on day 3 of treatment

SBP is common in chronic liver disease with ascites. Always consider if hepatic encephalopathy present

Send ascitic fluid in both blood culture bottles and in a universal container to microbiology

Treat for 7 days – IV route for at least 3 days depending on the clinical picture