Treatment of Spontaneous Bacterial Peritonitis in Adults (Age ≥18) with Community-Acquired Infection
Clinical Scenario
This protocol addresses adults aged 18 and older with community-acquired spontaneous bacterial peritonitis (SBP). Diagnosis is established by an ascitic fluid polymorphonuclear (PMN) leukocyte count greater than 250/mm³. Patients with nosocomial or health care-associated infection are excluded, as are those presenting with sepsis or septic shock.
Age ≥18
Community-acquired
Ascitic PMN >250/mm³
No sepsis / septic shock
No nosocomial infection
Treatment Approach (overview only)
Empirical IV antibiotic therapy — from the third-generation cephalosporin class — is initiated before culture results are available, alongside IV albumin supplementation. The complete regimen, specific agents, dosing schedule, and duration are detailed in the full structured protocol.
Treatment Goal
Response is evaluated by repeat diagnostic paracentesis at 48 hours after starting antibiotic therapy. A successful response requires a decrease in ascitic PMN count of at least 25% from baseline. Failure to reach this threshold indicates the need to broaden antibiotic coverage and to investigate for secondary peritonitis.
References
DOI: 10.1002/hep.31884
- The diagnosis of SBP/SBE is established with a fluid polymorphonuclear (PMN) leukocyte count >250/mm³.
- IV antibiotics should be started empirically (before obtaining culture results) in all patients with an ascites PMN count >250/mm³.
- First-line empirical antibiotic therapy for community-acquired SBP/SBE is IV third-generation cephalosporin.
- Currently, they are recommended as the first-line antibiotics (e.g., IV cefotaxime 2 g every 12 hours) in settings where MDROs are not prevalent (Table 9).
- The recommended duration of antibiotic therapy is 5 – 7 days.
- Patients with SBP should be treated with IV albumin in addition to antibiotics (1.5 g/kg at day 1 and 1 g/kg at day 3).
- It is recommended that a diagnostic paracentesis be performed 48 hours after initiating antibiotic therapy to assess response.
- A negative response is defined by a decrease in PMN count <25% from baseline and should lead to broadening the antibiotic spectrum and investigating secondary peritonitis (abdominal imaging studies).
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