From the Guidelines
For inpatient SBP prophylaxis, Rocephin (ceftriaxone) is typically dosed at 1 g every 12-24 hours intravenously. This recommendation is based on the most recent and highest quality study available, which suggests that ceftriaxone at a dose of 1 g every 12-24 hours is effective in treating SBP, with a resolution rate of 73-100% 1. The standard treatment duration is 5 to 10 days, but it should vary according to the symptoms and/or results of antimicrobial susceptibility testing.
- Key points to consider when using Rocephin for SBP prophylaxis include:
- Broad-spectrum coverage against enteric gram-negative bacteria, which are the most common causative organisms in SBP
- Good penetration into the ascitic fluid
- Convenient once-daily or every 12-24 hours dosing schedule
- It is essential to monitor renal function during therapy, as many cirrhotic patients have compromised kidney function.
- For long-term outpatient prophylaxis after discharge, oral antibiotics like norfloxacin or trimethoprim-sulfamethoxazole are typically preferred, so be prepared to transition the patient before discharge.
- The treatment regimen should be adjusted according to the susceptibility results of bacteria cultured from ascites or blood, and antibiotics should be replaced in accordance with these results 1.
From the Research
Dosing for Rocephin in SBP Prophylaxis
- The dosing for Rocephin (ceftriaxone) in spontaneous bacterial peritonitis (SBP) prophylaxis is not explicitly stated in the provided studies as a prophylactic dose.
- However, the studies provide information on the treatment of SBP using ceftriaxone:
- A study from 2014 2 compared the survival of patients with SBP who received 1g or 2g of ceftriaxone daily, suggesting that patients receiving 2g may have improved survival.
- A study from 2002 3 used a dose of 1.0g IV every 12 hours for 5 days to treat SBP in cirrhotic patients, with a resolution rate of 73% on day 5.
- A study from 2023 4 compared the efficacy of cefotaxime, ceftriaxone, and ciprofloxacin for the treatment of SBP, with no significant difference in resolution rates among the three groups.
- A clinical review from 2018 5 recommends timely antimicrobial therapy, including a third-generation cephalosporin such as ceftriaxone, for community-acquired SBP.
- A study from 2019 6 discusses the benefits and risks of antibiotic prophylaxis for SBP, but does not provide specific dosing information for ceftriaxone.