From the Guidelines
For recurrent Spontaneous Bacterial Peritonitis (SBP), the choice of antibiotics should be based on local epidemiology and individual patient risk factors, with consideration of the clinical severity of infection and the infection source. The most recent and highest quality study 1 recommends IV antibiotics, such as third-generation cephalosporins (e.g., cefotaxime), as the first-line treatment in settings where multi-drug resistant organisms (MDROs) are not prevalent. However, in areas with a high prevalence of MDROs or in patients with nosocomial infection or recent hospitalization, broader-spectrum antibiotics, such as carbapenems, may be necessary 1. Some key points to consider when choosing antibiotics for recurrent SBP include:
- The use of broad-spectrum antibiotics should be based on local epidemiology and individual patient risk factors 1
- The clinical severity of infection and the infection source should be taken into account when selecting empirical antibiotic therapy 1
- Regular monitoring of renal function is important during antibiotic treatment, as these patients often have compromised kidney function 1
- Addressing the underlying liver disease through appropriate management is crucial for comprehensive care 1 It is essential to note that the choice of antibiotics may vary depending on the specific clinical scenario and local resistance patterns, and antibiotic stewardship is crucial to minimize the development of resistance 1.
From the Research
Recurrent SBP Antibiotics Choice
- The choice of antibiotics for recurrent Spontaneous Bacterial Peritonitis (SBP) is crucial in reducing mortality and preventing further complications 2.
- A study comparing third-generation cephalosporins and carbapenems as initial antibiotics for recurrent SBP found that carbapenems significantly reduced all-cause mortality 2.
- The use of carbapenems, such as meropenem, is recommended in cases of recurrent SBP, especially when there is a high risk of multidrug-resistant bacteria 3.
- Third-generation cephalosporins, such as cefotaxime, are also effective in treating SBP, but may not be as effective as carbapenems in cases of recurrent SBP 2, 4, 5.
- The choice of antibiotic should be based on the patient's individual risk factors, such as advanced age, refractory ascites, and previous diagnosis of SBP 3, 6.
- It is essential to collect blood, urine, and ascitic fluid for cultures to guide antibiotic therapy and reduce the risk of multidrug-resistant bacteria 3, 6.
Antibiotic Regimens
- Cefotaxime 2 g every 8 hours for 5 days is a commonly recommended regimen for SBP 4, 5.
- Meropenem or piperacillin-tazobactam may be used as alternative antibiotics in cases of recurrent SBP or multidrug-resistant bacteria 3, 6.
- Levofloxacin may be used as an alternative antibiotic in patients who are not receiving long-term fluoroquinolone prophylaxis or have a penicillin allergy 6.