From the Guidelines
Spontaneous bacterial peritonitis (SBP) treatment requires immediate antibiotic therapy with a third-generation cephalosporin, typically ceftriaxone 2g IV daily for 5-7 days, as recommended by the most recent guidelines 1. The choice of antibiotic should be guided by the severity of infection, local bacterial resistance profiles, and whether the infection is community-acquired or nosocomial 1. Some key points to consider in the treatment of SBP include:
- Empirical antibiotic therapy should be started immediately following the diagnosis of SBP, without waiting for culture and antibiotic susceptibility test results 1.
- Albumin infusion (1.5 g/kg on day 1 and 1 g/kg on day 3) is recommended to prevent renal dysfunction and reduce mortality, particularly in patients with serum creatinine >1 mg/dL, BUN >30 mg/dL, or bilirubin >4 mg/dL 1.
- Patients should be monitored with repeat paracentesis at 48 hours to confirm treatment response, indicated by a decrease in neutrophil count by at least 25% 1.
- The treatment duration should vary according to the symptoms and/or results of antimicrobial susceptibility testing, and antibiotics should be replaced in accordance with the susceptibility results of bacteria cultured from ascites or blood 1.
- Secondary prophylaxis with norfloxacin 400mg daily or trimethoprim-sulfamethoxazole is essential to prevent recurrence after resolution of SBP 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
SBP Treatment Overview
- Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis, typically involving infection with a single organism, such as Escherichia coli, Klebsiella spp, and Streptococcus spp 2.
- The treatment of choice for SBP is cefotaxime 2 g given intravenously every 8 hours for a total of 5 days, with the antibiotic regimen adjusted based on the results of ascitic fluid cultures 2.
Antibiotic Regimens
- Third-generation cephalosporins, such as cefotaxime and ceftazidime, have been considered first-line treatments for SBP 2, 3.
- However, a broader-spectrum antibiotic regimen, such as meropenem plus daptomycin, may be more effective in the treatment of nosocomial SBP, especially in cases where bacteria are resistant to third-generation cephalosporins 3.
- Ceftriaxone is also a safe and effective option for the treatment of SBP, with a marked decrease in ascitic fluid polymorphonuclear count during treatment 4.
Prevention and Prophylaxis
- Efforts to prevent the development and recurrence of SBP with antibiotic prophylaxis are warranted, particularly in individuals with low-protein ascites and those awaiting liver transplantation 2.
- Selective intestinal decontamination (SID) with the oral fluoroquinolone norfloxacin is the most extensively studied form of prophylaxis, and is recommended for individuals with low-protein ascites and those with a history of SBP 2, 5.
Treatment Outcomes
- The infection-related mortality associated with SBP has decreased to less than 10%, but hospitalization-related mortality remains high, ranging from 24% to 30% 2, 4.
- The simultaneous administration of intravenous albumin and antibiotics for SBP has been shown to result in decreased development of azotemia and hospitalization-related mortality 2.
- Factors related to hospital mortality include gastrointestinal hemorrhage, hepatic encephalopathy, renal failure, and ascitic fluid polymorphonuclear count 4.