What Causes SBP
- Gram-Negative Bacteria (50%)
- E.coli (37%)
- Klebsiella
- other
- Gram-Positive Bacteria (50%)
- Strep pneumonia (10%)
- Other Strep
- Staphylococcus aureus
Treatment of SBP
- SPB has a high mortality rate. Start treatment immediately.
- If ascitic fluid polymorphonuclear cell count is greater than 250, start antibiotics. (PMN= total number of white cells * % of neutrophils)
- Poorer prognosis if bilirubin < 8, albumin < 2.5 or creatinine > 2.1
- Antibiotic therapy + albumin, 5-10 days (5 days just as effective as 10).
- Community acquired SBP (gram – coverage): 3rd gen ceph IV cefotaxime 2g IV every 8 hours or IV ceftriaxone 1 G BID, PCN allergy: IV levo 500 mg QD
- Hospital acquired SBP (expand to MDROs): previous cultures pip/tazo 3.375 every 6 hours and vanc, carbapenem if concerned about ESBL.
- In patients at high risk, prevention is needed. Ceftriaxone or norfloxacin.
Prophylaxis of SBP
Patients who survive an episode of spontaneous bacterial peritonitis should receive long term prophylaxis with daily norfloxacin (levofloxacin) or trimethoprim/sulfamethoxazole.
Antibiotics for infection prophylaxis after a GI bleed is typically with intravenous ceftriaxone and only lasts for a total of 7 days. Once the bleeding has stopped it is also possible to transition to oral antibiotics with ciprofloxacin or TMP/SMX to complete the 7-day antibiotic course.
*From the Liver Fellow Network