Spontaneous Bacterial Peritonitis (SBP) in patients with chronic liver disease

Important: Therapy

Treat if

• ascitic fluid neutrophil count is >0.25 x 10⁹/L or

• ascitic fluid white cell count of >0.5 x 10⁹/L

 

Prescribe prophylaxis (Co-trimoxazole 960mg oral every 24 hours) only:

• for duration of hospital admission if no signs of infection but ascitic protein fluid concentration is low (<10g/L)
• long-term prophylaxis following an episode of SBP in patients with chronic liver disease

Notes:

Important: Therapy

If IV route required:

IV Co-trimoxazole* 960mg 12 hourly

  

Oral switch

Co-trimoxazole 960mg 12 hourly

Notes:

*If Co-trimoxazole IV unavailable & IV route required use Ciprofloxacin 400mg IV 12 hourly. Oral switch remains co-trimoxazole.

Important: Therapy

If IV route required:

IV Ciprofloxacin 400mg 12 hourly

 

Oral Switch

Ciprofloxacin 500mg 12 hourly

Notes:

Avoid ciprofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF & give MHRA patient information leaflet to patient