Diuretic-resistant ascites: Lack of response (weight loss < 200 g/day and urinary sodium excretion < 50 mmol/day) on a 50-mmol sodium/day diet and maximal doses of diuretics (spironolactone 400 mg/day and furosemide 160 mg/day for 2 weeks).

Diuretic-intractable ascites: Development of diuretic-induced complications such as severe electrolyte disturbances, renal impairment, or hepatic encephalopathy, precluding the use of an effective diuretic dose.

Severity of liver disease (70% of all SBP episodes are in patients with Child-Pugh class C cirrhosis) Ascitic fluid total protein level of < 1 g/dL and/or ascitic fluid complement factor C3 < 13 mg/dL Gastrointestinal bleeding Urinary tract infections Intestinal bacterial overgrowth Iatrogenic sources of bacteremia such as urinary bladder and intravascular catheters One or more previous SBP episodes Serum bilirubin of > 2.5 mg/dL

Fever	69%
Abdominal pain	59%
Hepatic encephalopathy	54%
Abdominal tenderness	49%
Diarrhea	32%
Ileus	30%
Shock	21%
Hypothermia	17%
Asymptomatic	10%

At the beginning of each admission to hospital:

Symptoms or signs of peritoneal infection -abdominal pain, rebound tenderness, vomiting, diarrhea, ileus Systemic signs of infection -fever, leukocytosis, septic shock Hepatic encephalopathy or rapid impairment in renal function without clear precipitant Gastrointestinal bleeding before starting prophylactic antibiotics

Cefotaxime 2 g intravenously every 12 hours x minimum of 5 days Other cephalosporins (cefonicid, ceftriaxone, ceftizoxime, ceftazidime) Amoxicillin (1 g) and clavulanic acid (200 mg) intravenously 3 times daily x ~5 days, then orally 500 mg/125 mg 3 times daily x ~3 days Ciprofloxacin 200 mg intravenously every 12 hours x 7 days Ciprofloxacin 200 mg intravenously every 12 hours x 2 days then 500 mg orally every 12 hours x 5 days

In nonbleeding cirrhotic patients with ascites: Recovering from an SBP episode -continuous oral administration of norfloxacin 400 mg daily or ciprofloxacin 750 mg weekly -consider liver transplantation Without past history of SBP and with -high ascitic fluid protein (> 10 g/dL): no prophylaxis necessary -low ascitic fluid protein (< 10 g/dL): no consensus on the necessity of prophylaxis In cirrhotics with upper gastrointestinal hemorrhage: Exclusion of SBP and other infections before prophylaxis Oral administration of norfloxacin 400 mg every 12 hours x minimum of 7 days Alternative regimens: -ofloxacin 400 mg/day x 10 days (first intravenously, then orally) and with each endoscopy 1 g of amoxicillin/200 mg clavulanic acid -ciprofloxacin 500 mg twice daily x 7 days orally or via nasogastric tube after endoscopy -amoxicillin/clavulanic acid 1 g/200 mg 3 times daily and ciprofloxacin 200 mg twice daily intravenously then orally until 3 days after cessation of bleeding