What are the treatment guidelines for spontaneous bacterial peritonitis (SBP)?

Updated: Nov 26, 2018
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

The American Association for the Study of Liver Diseases (AASLD) has issued updated guidelines for adult patients with ascites due to cirrhosis. [19]

A 2009 guideline from the American Association for the Study of Liver Diseases recommends that adult cirrhotic patients with ascitic fluid polymorphonuclear neutrophil (PMN) counts of 250 cells/µL or greater in a community-acquired setting (in the absence of recent beta-lactam antibiotic exposure) should receive empiric antibiotic therapy (eg, an intravenous third-generation cephalosporin, preferably cefotaxime 2 g every 8 hours). Patients with cirrhosis who have PMN counts of 250 cells/µL or more in a nosocomial setting or patients who have recently received beta-lactam antibiotics should receive empiric antibiotic therapy based on local susceptibility testing of bacteria. [4, 19] As an alternative to intravenous cefotaxime, inpatients with cirrhosis can be treated with oral ofloxacin (400 mg twice per day), if none of the following contraindications are present [4] :

  • Prior exposure to quinolones

  • Vomiting

  • Shock

  • Grade II (or higher) hepatic encephalopathy

  • Serum creatinine greater than 3 mg/dL


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