Adult
Spontaneous Bacterial Peritonitis (SBP)
Warning
- SBP is likely when ascitic fluid neutrophil count is more than 250 cells/mm3 or more than 0.25 x109/L.
- Ascitic fluid should be sent for culture and blood cultures performed at the same time, before starting antibiotics, in patients admitted to hospital
- Review at 3 days if culture positive and tailor therapy to sensitivity result and advice from Micro/ID.
Spontaneous bacterial peritonitis (SBP)
Preferred including non-severe and severe penicillin allergy or MRSA positive
co-trimoxazole 960mg po/iv (iv only if NBM) bd
Alternative
ceftriaxone 2g iv od OR if able to take orally cefalexin 1g po tds
For severe penicillin allergy: speak to Micro/ID
Spontaneous bacterial peritonitis (SBP) prophylaxis
Do not routinely offer antibiotics to prevent spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites.
Consider antibiotics to prevent SBP only if:
- the person is at high risk of developing SBP because they have severe liver disease (for example, they have an ascitic protein of 15g/L or less, a Child–Pugh score of more than 9, or a MELD score of more than 16) OR
- the consequences of an infection could seriously impact the person's care, for example, if it could affect their wait for a transplant or a transjugular intrahepatic portosystemic stent insertion (TIPS).
Preferred including non-severe and severe penicillin allergy or MRSA positive
co-trimoxazole 960mg po od
If CrCl less than 30ml/min: co-trimoxazole 480mg po od
Review antibiotic prophylaxis for SBP at least every 6 months, with the review to include:
- Assessing the success of prophylaxis,
- Discussion of continuing, stopping or changing prophylaxis (taking into account the person's preferences for antibiotic use and the risk of antimicrobial resistance)
Stop prophylaxis either when ascites have resolved or at review (see above) whichever is sooner.