Peritonitis, Spontaneous Bacterial Peritonitis (SBP) Treatment and Prophylaxis

Criteria & Principles

Empiric therapy for SBP should be started in a patient with ascites who has one or more of the following findings:

• Temperature > 37.8 C
• Abdominal pain and/or tenderness
• Change in mental status
• Ascitic fluid PMN count >=250 cells/mm³

Treatment

Duration

5 days

• Diagnostic paracentesis may be performed 48 hours after initiating antibiotic therapy to assess response
• Response is defined as a decrease in PMN count > 25% from baseline.  Lack of response should lead to broadening the antibiotic spectrum and investigating secondary peritonitis
• Repeat paracentesis may be unnecessary if:
  
  • An organism is isolated and susceptible to antibiotic used AND
  • Patient is improving clinically

NOTE: IV albumin should be administered on days 1 (1.5g/kg) and 3 (1g/kg).

Severity

All Severity

Treatment

Prophylaxis