From the Guidelines
Spontaneous Bacterial Peritonitis (SBP) should be treated with empirical antibiotics immediately after diagnosis, with the choice of antibiotic guided by the context of SBP (community-acquired or health-care associated), severity of infection, and local bacterial resistance profile 1.
Empirical Antibiotic Therapy
- Third-generation cephalosporins, such as cefotaxime (2 g every 12 hours), are recommended as first-line antibiotics in settings where multi-drug resistant organisms (MDROs) are not prevalent 1.
- In areas with a high prevalence of MDROs, or in patients with nosocomial infection, severe sepsis, or recent hospitalization, broader-spectrum antibiotics such as carbapenems (e.g., meropenem) may be necessary 1.
- Amoxicillin/clavulanic acid and ciprofloxacin are alternative options, but their use should be guided by local resistance patterns and patient-specific factors 1.
Additional Treatment
- IV albumin (1.5 g/kg at day 1 and 1 g/kg at day 3) should be administered in addition to antibiotics to improve outcomes in patients with SBP 1.
- Non-selective beta blockers (NSBBs) should be temporarily held in patients with SBP who develop hypotension or acute kidney injury (AKI) 1.
Monitoring and Adjustment
- Diagnostic paracentesis should be repeated 2 days after initiation of antibiotic therapy to assess response and guide further management 1.
- Antibiotic coverage should be narrowed as soon as culture results are available, and antibiotics should be given for as short a time as possible to minimize the risk of resistance and adverse effects 1.
From the Research
Treatment Overview
The treatment for Spontaneous Bacterial Peritonitis (SBP) typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of multidrug-resistant (MDR) bacteria 2, 3, 4, 5.
Antibiotic Treatment
- Third-generation cephalosporins, such as ceftriaxone, cefotaxime, or ciprofloxacin, have been considered the first-line treatment for SBP 2, 3, 5.
- However, in areas with high rates of MDR bacteria, broad-spectrum antibiotics, such as meropenem plus daptomycin, may be recommended as empiric therapy 3, 4.
- Alternative antibiotics, such as pipercillin-tazobactam, may be considered for patients with nosocomial SBP or for patients who fail to improve on traditional antibiotic regimens 5.
- Levofloxacin is an acceptable alternative for patients not receiving long-term flouroquinolone prophylaxis or for those with a penicillin allergy 5.
Adjunctive Treatment
- Selective albumin supplementation remains an important adjunct in SBP treatment 5.
- Withholding acid suppressive medication and discontinuing beta-adrenergic antagonist therapy in patients with end-stage liver disease and resistant ascites is standard care 5.
Treatment Efficacy
- The efficacy of antibiotic treatment for SBP has been evaluated in several studies, with varying results 3, 6.
- A network meta-analysis found no evidence of difference in mortality, serious adverse events, or resolution of SBP between different antibiotic treatments, although the certainty of the evidence was very low 6.
- A randomized controlled trial found that the combination of meropenem plus daptomycin was more effective than ceftazidime in the treatment of nosocomial SBP 3.