Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management Ascites PMN > 250/mm3 ? Nosocomial or hospital acquired. Recent exposure to antibiotics, Presentation in septic shock yes → Broad-spectrum coverage (Piperacillin/Tazobactam) no → 3rd gen cephalosporine (ceftriaxone, cefotaxime) SBP: Medical Management Repeat tap: - 2 days after empirical antibiotic therapy to confirm response - ↓ PMN <25% from baseline indicates lack of response Give IV albumin, especially in patients with AKI and/or jaundice. Secondary prophylaxis - Best evidence: long-term prophylaxis with daily norfloxacin, Ciprofloxacin is acceptable Upper Gl bleeding: Short-term (< 7 days) antibiotic (ceftriaxone 1g/24h) prophylaxis Primary prophylaxis with ciprofloxacin may be considered if: Low protein (< 1.5g/L) ascites, Renal dysfunction or liver failure #Spontaneous #Bacterial #Peritonitis #SBP #Diagnosis #Management #hepatology
