From the Guidelines
Yes, patients who have had spontaneous bacterial peritonitis (SBP) require long-term prophylactic antibiotics to prevent recurrence. The recommended regimen is norfloxacin 400 mg orally once daily or trimethoprim-sulfamethoxazole (one double-strength tablet) orally once daily. If these are unavailable, ciprofloxacin 500 mg orally once daily can be used as an alternative. This prophylaxis should be continued indefinitely, especially in patients with ongoing risk factors such as advanced cirrhosis or low ascitic fluid protein levels (<1.5 g/dL) 1.
Rationale for Prophylaxis
The rationale for prophylaxis is that SBP has a high recurrence rate of approximately 70% within one year without preventive treatment 1. These antibiotics work by suppressing the growth of enteric gram-negative bacteria, which are the most common causative organisms in SBP. The bacteria typically translocate from the intestinal lumen into the ascitic fluid, and prophylactic antibiotics reduce this bacterial translocation.
Key Considerations
It's essential to note that while on prophylaxis, patients should still be monitored regularly for signs of recurrent infection, development of resistant organisms, and potential antibiotic side effects 1. The choice of antibiotic should be guided by local resistance patterns and protocol 1.
Monitoring and Follow-up
Regular monitoring of patients on prophylaxis is crucial to ensure the effectiveness of the treatment and to minimize the risk of complications. This includes regular diagnostic paracentesis to check for signs of recurrent infection and monitoring for potential antibiotic side effects 1.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Prophylactic Antibiotics for Spontaneous Bacterial Peritonitis (SBP)
- The use of prophylactic antibiotics in patients with SBP is a topic of interest, with various studies investigating its efficacy in preventing recurrence and improving survival 2, 3, 4, 5, 6.
- A study published in the Journal of Hepatology in 2008 found that long-term administration of ciprofloxacin reduced the risk of SBP and improved survival in cirrhotic patients with low protein concentration in ascitic fluid 2.
- A meta-analysis published in The American Journal of Gastroenterology in 2009 found that oral antibiotic prophylaxis reduced the occurrence of SBP and improved short-term survival in cirrhotic patients with ascites 3.
- Another study published in The Annals of Pharmacotherapy in 2010 found that prophylactic antibiotic therapy was warranted for the prevention of recurrent SBP in patients with cirrhosis and ascites, and that primary prophylaxis may be considered in patients with low ascetic fluid protein and at least one more risk factor 4.
- A review published in Expert Review of Anti-Infective Therapy in 2006 found that patients who have already had a previous episode of SBP benefit from prophylactic treatment, and that cirrhotic patients with a high risk of SBP and other infections also benefit from primary prophylaxis 5.
- However, a more recent study published in Annals of Hepatology in 2019 found that daily, intermittent, or no secondary antibiotic prophylaxis had similar outcomes in terms of recurrence and mortality in patients with a history of SBP, suggesting that traditional approaches to secondary SBP prophylaxis may need to be re-evaluated 6.
Patient Selection for Prophylactic Antibiotics
- Patients with cirrhosis and low protein concentration in ascitic fluid are candidates for long-term prophylaxis to reduce the risk of infections and improve survival 2.
- Patients with a history of SBP, particularly those with a high risk of recurrence, may benefit from prophylactic antibiotic therapy 3, 4, 5.
- Patients with gastrointestinal bleeding are also at high risk of SBP and may benefit from primary prophylaxis 5.