What is the recommended treatment for Spontaneous Bacterial Peritonitis (SBP) using Rocephin (ceftriaxone)?

From the Guidelines

For spontaneous bacterial peritonitis (SBP), ceftriaxone (Rocephin) is recommended as a first-line antibiotic, particularly in settings where multidrug-resistant organisms (MDROs) are not prevalent, at a dose of 1-2 grams intravenously once daily for 5-7 days, as supported by the most recent guidelines 1.

Key Considerations

• The diagnosis of SBP is confirmed by an ascitic fluid analysis showing an elevated polymorphonuclear leukocyte count ≥250 cells/mm³.
• Treatment should be initiated immediately after diagnosis, with empirical antibiotics started before obtaining culture results.
• In addition to antibiotic therapy, patients should receive intravenous albumin to reduce the risk of renal impairment and improve survival.
• The choice of antibiotic may need to be adjusted based on local resistance profiles and the severity of infection, with a consideration for broader coverage in cases of nosocomial infection or critically ill patients.

Antibiotic Therapy

• Ceftriaxone is effective against most common causative organisms in SBP, particularly Escherichia coli and other gram-negative bacteria.
• It achieves good penetration into the ascitic fluid and has a convenient once-daily dosing schedule.
• The higher dose (2g) is often preferred in more severe cases or in patients with higher body weight.

Management and Prevention

• After completing the antibiotic course, long-term prophylaxis with daily oral antibiotics may be recommended for patients who have recovered from an episode of SBP to prevent recurrence, especially in those with advanced liver disease.
• A second diagnostic tap should be considered at 48 hours from starting treatment to check the efficacy of antibiotic therapy.
• Specialist microbiology links should be developed to help guide local policy and patient management, with a recommendation for de-escalation of anti-microbial agents according to susceptibility of positive cultures 1.

From the Research

Treatment of Spontaneous Bacterial Peritonitis (SBP) with Rocephin (Ceftriaxone)

• The recommended treatment for SBP typically involves the use of broad-spectrum antibiotics, with cefotaxime being a commonly cited choice 2.
• However, ceftriaxone (Rocephin) has been studied as an alternative treatment option for SBP, with studies showing it to be a safe and effective choice 3, 4.
• One study found that ceftriaxone (1g every 12 hours) resulted in a marked decrease in ascitic fluid polymorphonuclear (PMN) count, with 33% of cases achieving a PMN count of < 250 cells/mm3 within 4 days of treatment 3.
• Another study demonstrated that a short course of ceftriaxone (5 days) was sufficient to cure SBP in cirrhotic patients, with a resolution rate of 73% on day 5 of treatment and a total resolution rate of 94% after prolonged therapy 4.

Dosage and Administration

• The dosage of ceftriaxone for SBP is typically 1g every 12 hours, administered intravenously 3, 4.
• The duration of treatment is usually 5 days, but may be extended based on the patient's response to therapy and the results of ascitic fluid cultures 4.

Efficacy and Safety

• Ceftriaxone has been shown to be effective in treating SBP, with a low hospital mortality rate of 12-24% 3, 4.
• The use of ceftriaxone is generally well-tolerated, with no significant adverse effects reported in the studies reviewed 3, 4.

Comparison to Other Antibiotics

• Ceftriaxone is considered a good initial choice for SBP treatment, along with other third-generation cephalosporins 5.
• Levofloxacin is an acceptable alternative for patients not receiving long-term fluoroquinolone prophylaxis or for those with a penicillin allergy 5.