Spontaneous Bacterial Peritonitis
Antimicrobial prescribing: NHS Fife
Clinical features
- Abdominal pain
- Worsening abdominal distension
- Known chronic liver disease
Investigations
- Ascitic fluid (in universal container and in blood culture bottles)
- Blood culture
Infection Control
Basic universal precautions
Treatment
TEMOCILLIN IV 2g 8 hourly
PLUS
AMOXICILLIN IV 1g 8 hourly
PLUS
METRONIDAZOLE IV 500mg 8 hourly
If known / suspected MRSA:
TEMOCILLIN IV 2g 8 hourly
PLUS
VANCOMYCIN IV (dose as per calculator)
PLUS
METRONIDAZOLE IV 500mg 8 hourly
If true penicillin allergy:
VANCOMYCIN IV (dose as per calculator)
PLUS
CIPROFLOXACIN IV 400mg 12 hourly (review MHRA Safety Advice before prescribing)
PLUS
METRONIDAZOLE IV 500mg 8 hourly
When improving, consider IV to Oral switch as for intra-abdominal sepsis
Duration: 5-7 days in total