From the Guidelines
For spontaneous bacterial peritonitis (SBP), the recommended dose of Rocephin (ceftriaxone) is 1 g every 12-24 hours, as stated in the most recent and highest quality study 1. This dose is effective against most common causative organisms in SBP, particularly Escherichia coli and other gram-negative bacteria. The treatment should be initiated as soon as SBP is suspected, even before culture results are available. Some key points to consider when treating SBP include:
- The dosage generally does not need adjustment for patients with renal impairment, but may need modification in severe hepatic dysfunction.
- Before starting treatment, a diagnostic paracentesis should be performed to confirm the diagnosis, with a polymorphonuclear cell count ≥250 cells/mm³ in ascitic fluid being diagnostic for SBP.
- Blood cultures should also be obtained.
- Ceftriaxone achieves good penetration into the peritoneal fluid and has a long half-life allowing for once-daily dosing.
- After completing the antibiotic course, secondary prophylaxis with daily oral antibiotics (typically norfloxacin or trimethoprim-sulfamethoxazole) is recommended for patients who have recovered from an episode of SBP to prevent recurrence, as suggested by 1. It's also important to note that the standard treatment duration is 5 to 10 days, but the treatment duration should vary according to the symptoms and/or results of antimicrobial susceptibility testing, as stated in 1. Additionally, antibiotics should be replaced in accordance with the susceptibility results of bacteria cultured from ascites or blood. Other treatment options, such as cefotaxime and amoxicillin-clavulanic acid, have also shown similar efficacy to ceftriaxone in treating SBP, as reported in 1 and 1. However, the choice of antibiotic should be guided by the local resistance profile and the severity of the infection, as emphasized in 1.
From the Research
Rocephin Dose in SBP
- The recommended dose of ceftriaxone (Rocephin) for the treatment of spontaneous bacterial peritonitis (SBP) is 1g every 12 hours for 5 days 2, 3.
- Ceftriaxone is a safe and effective option for the treatment of SBP, with a hospital mortality rate of 12-24% 2, 3.
- The resolution of SBP on day 5 of treatment with ceftriaxone was achieved in 73% of patients, and total resolution after prolonged therapy was achieved in 94% of patients 3.
- Third-generation, broad-spectrum cephalosporins, such as ceftriaxone, remain a good initial choice for SBP treatment 4.
Alternative Antibiotic Regimens
- Other antibiotic regimens for SBP, such as cefotaxime, are less well studied, but may be effective in certain cases 5.
- Levofloxacin is an acceptable alternative for patients not receiving long-term fluoroquinolone prophylaxis or for those with a penicillin allergy 4.
- Alternative antibiotics, such as piperacillin-tazobactam, should be considered for patients with nosocomial SBP or for patients who fail to improve on traditional antibiotic regimens 6, 4.