This protocol applies to patients with liver cirrhosis and ascites who present with community-acquired spontaneous bacterial peritonitis (SBP).
Management centers on prompt empirical intravenous antibiotic therapy — with antibiotic class selection guided by local bacterial resistance patterns — combined with albumin infusion. The full antibiotic selection criteria, duration, and dosing are available in the structured protocol.
A second paracentesis at 48 hours confirms antibiotic efficacy. The target is at least a 25% reduction in ascitic fluid neutrophil count from the baseline measurement.
The diagnosis of SBP is based on neutrophil count in ascitic fluid of >250/mm³ (II-2;1).
Empirical i.v. antibiotics should be started immediately following the diagnosis of SBP (II-2;1).
Third-generation cephalosporins are recommended as first-line antibiotic treatment for community-acquired SBP in countries with low rates of bacterial resistance (I;1). In countries with high rates of bacterial resistance piperacillin/tazobactam or carbapenem should be considered (II-2;1).
The duration of treatment should be at least 5–7 days (III;1).
The administration of albumin (1.5 g/kg at diagnosis and 1 g/kg on day 3) is recommended in patients with SBP (I;1).
The efficacy of antibiotic therapy should be checked with a second paracentesis at 48 h from starting treatment. Failure of first-line antibiotic therapy should be suspected if there is worsening of clinical signs and symptoms and/or increase or no marked reduction in leucocyte count (at least 25%) in 48 h (II-2;1).
DOI: 10.1016/j.jhep.2018.03.024
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