Treatment of Ascites in Liver Cirrhosis when Ascitic Fluid Neutrophil Count Exceeds 250 cells/mm³
This protocol applies to patients with liver cirrhosis and ascites in whom the ascitic fluid neutrophil count exceeds 250 cells/mm³, who are symptomatic, and who do not have developing renal impairment. Prompt treatment is required in this clinical scenario.
Clinical Scenario
- Underlying liver cirrhosis with ascites
- Ascitic fluid neutrophil count >250 cells/mm³
- Patient is symptomatic (not clinically well)
- No developing renal impairment
Treatment Approach (partial)
The protocol calls for empiric intravenous antibiotic therapy with a third-generation cephalosporin. The evidence base also supports specific alternative agents.
The complete regimen — including agent selection, dosing, duration, and alternatives — is available in the full protocol.
Treatment Goal
A reduction in ascitic fluid neutrophil count of at least 25% of the pretreatment value after two days of treatment, with improvement in symptoms and signs.
References
DOI: 10.1136/gut.2006.099580
- The diagnosis of SBP is confirmed when ascitic neutrophil count is >250 cells/mm³ (0.25×10&sup9;/l) in the absence of an intra-abdominal and surgically treatable source of sepsis.
- In patients with an ascitic fluid neutrophil count of >250 cells/mm³, empiric antibiotic therapy should be started.
- Third generation cephalosporins such as cefotaxime have been most extensively studied in the treatment of SBP and have been shown to be effective.
- Other cephalosporins, such as ceftriaxone and ceftazidime as well as co-amoxiclav (amoxicillin plus clavulanic acid), have been shown to be as effective as cefotaxime in resolving SBP.
- A reduction in ascitic fluid neutrophil count of less than 25% of the pretreatment value after two days of antibiotic treatment suggests failure to respond to therapy.
- Resolution of infection in SBP is associated with an improvement in symptoms and signs.
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