Spontaneous Bacterial Peritonitis (SBP) in patients with chronic liver disease

Micro-organism

Escherichia coli, Gram positive cocci, Enterococci

Duration

7-10 Days

Notes

Treat if

• ascitic fluid neutrophil count is >0.25 x 109/L or

• ascitic fluid white cell count of >0.5 x 109/L

 

 Prescribe prophylaxis (Co-trimoxazole 960mg oral every 24 hours) only: 

  • for duration of hospital admission if no signs of infection but ascitic protein fluid concentration is low (<10g/L)
  • long-term prophylaxis following an episode of SBP in patients with chronic liver disease
1st line

If IV route required:

IV Co-trimoxazole* 960mg 12 hourly

  

Oral switch

Co-trimoxazole 960mg 12 hourly

*If Co-trimoxazole IV unavailable & IV route required use Ciprofloxacin 400mg IV 12 hourly. Oral switch remains co-trimoxazole.

2nd line

If IV route required:

IV Ciprofloxacin 400mg 12 hourly

 

Oral Switch

Ciprofloxacin 500mg 12 hourly