Spontaneous bacterial peritonitis

First Line

Piperacillin/Tazobactam (Tazocin) 4.5g IV 8 hourly

Vancomycin IV as per protocol AND Ciprofloxacin 400mg IV 12 hourly (consider safety issues) AND Metronidazole 500mg IV 8 hourly

If on ciprofloxacin as prophylaxis

Vancomycin IV as per protocol AND Gentamicin IV as per protocol 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