Spontaneous Bacterial Peritonitis

First Line

Piperacillin/Tazobactam (Tazocin) 4.5g IV 8 hourly

Vancomycin IV (as per online calculator) AND Ciprofloxacin 400mg IV 12 hourly (consider safety issues) AND Metronidazole 400mg PO 8 hourly

If on ciprofloxacin as prophylaxis

Vancomycin IV (as per online calculator) AND Gentamicin IV (as per online calculator) AND Metronidazole 500mg IV 8hrly

Should be given to all patients with a history of previous SBP and those with a confirmed ascitic protein content <15g/l

CHECK PREVIOUS SENSITIVITIES OF ASCITIC FLUID CULTURES TO INFORM CHOICE

First line:

Co-trimoxazole 960mg PO once daily (eGFR>30ml/min) or 480mg once daily (eGFR< 30ml/min)

Co-trimoxazole allergic patient or second line:

Ciprofloxacin 750mg PO weekly (consider safety issues)

Defined clinically as ascitic polymorph count >250 cells mm3

Give antibiotics in conjunction with intravenous albumin (20%): 1.5g/kg on day 1, then 1.0g/kg on day 3 of treatment

SBP is common in chronic liver disease with ascites. Always consider if hepatic encephalopathy present

Send ascitic fluid in a white top universal container and blood culture bottles to microbiology

Treatment duration: 7 days

Oral switch guidance

Review culture results first. If no positive microbiology results to guide:

Preferred regime - Co-amoxiclav 625mg PO 8 hourly

Alternative - Co-trimoxazole 960mg PO 12 hourly OR Levofloxacin 500mg PO 12 hourly (consider safety issues) AND Metronidazole 400mg 8 hourly