From the Guidelines
The treatment for spontaneous bacterial peritonitis (SBP) primarily involves prompt antibiotic therapy, with empiric antibiotic treatment started immediately after diagnosis with a third-generation cephalosporin such as ceftriaxone (1-2g IV daily) or cefotaxime (2g IV every 8 hours) for 5-7 days, as recommended by the most recent guidelines 1.
Key Considerations
- Empiric antibiotic treatment should be initiated immediately after the diagnosis of SBP, without waiting for culture results 1.
- Third-generation cephalosporins, such as cefotaxime or ceftriaxone, are the recommended first-line antibiotics for SBP, due to their effectiveness against common causative organisms, including gram-negative enteric bacteria like E. coli and Klebsiella 1.
- In patients with healthcare-associated SBP or recent antibiotic exposure, broader coverage with piperacillin-tazobactam or meropenem may be necessary due to potential resistant organisms 1.
- Albumin infusion (1.5 g/kg on day 1 and 1 g/kg on day 3) should be administered alongside antibiotics in patients with renal dysfunction or severe liver disease to prevent hepatorenal syndrome 1.
- After treatment, secondary prophylaxis with norfloxacin (400mg daily) or trimethoprim-sulfamethoxazole (one double-strength tablet daily) is recommended to prevent recurrence in high-risk patients 1.
Monitoring and Adjustment
- A second diagnostic paracentesis at 48 hours from the start of treatment may be considered to check the efficacy of antibiotic therapy and to guide further management 1.
- If ascitic fluid neutrophil count fails to decrease to less than 25% of the pretreatment value, this should raise suspicion of antibiotic resistance or the presence of secondary peritonitis, and specialist microbiology links should be developed to help guide local policy and patient management 1.
From the Research
Treatment for Spontaneous Bacterial Peritonitis
The treatment for spontaneous bacterial peritonitis (SBP) typically involves the use of antibiotics. The choice of antibiotic may depend on various factors, including the severity of the infection and the presence of any underlying medical conditions.
- Third-generation cephalosporins: These are often considered the first-line treatment for SBP, with cefotaxime being a commonly used option 2. A study published in 1995 found that cefotaxime was effective in treating SBP, with a dosage of 2 g every 6 h being adequate for most patients.
- Ceftriaxone: This is another antibiotic that has been shown to be effective in treating SBP, with a study published in 1998 finding that a 5-day course of ceftriaxone was effective in resolving the infection in 95% of patients 3.
- Carbapenems: These are a class of antibiotics that may be used to treat SBP, particularly in patients with severe infections or those who are at risk of developing resistant bacteria 4. A study published in 2021 found that carbapenems were associated with lower in-hospital mortality rates compared to third-generation cephalosporins in patients with high chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores.
- Meropenem plus daptomycin: This combination of antibiotics has been shown to be effective in treating nosocomial SBP, with a study published in 2016 finding that it was more effective than ceftazidime in resolving the infection 5.
Key Considerations
When treating SBP, it is essential to consider the following factors:
- Dosage and duration of treatment: The dosage and duration of antibiotic treatment may vary depending on the severity of the infection and the patient's response to treatment.
- Resistance to antibiotics: The development of resistant bacteria is a significant concern in the treatment of SBP, and antibiotic choices should be guided by susceptibility testing whenever possible.
- Underlying medical conditions: Patients with underlying medical conditions, such as liver cirrhosis, may require more intensive treatment and monitoring.
- Long-term antibiotic prophylaxis: Patients who have had a previous episode of SBP may require long-term antibiotic prophylaxis to prevent recurrence 6.