Indications for Spontaneous Bacterial Peritonitis (SBP) Prophylaxis

Antibiotic prophylaxis for patients with risk factors for spontaneous bacterial peritonitis (SBP) include:

• Known history of SBP: Typically prolonged outpatient fluoroquinolone or TMP-SMX
• Cirrhotic patients with GI bleed: Ceftriaxone 1g q24hrs [5 days]
• Patients found to have ascites with ascitic total protein concentration <1.5g/dL or 15g/L with the following comorbidities: Cr >106 micromol/L, serum sodium ≤130 mEq/L, Liver failure is defined as a Child-Pugh score ≥9 (CP C and above) or a bilirubin ≥3 mg/dL (51 micromol/L).

REFERENCES

1. Alaniz C, Regal RE. Spontaneous Bacterial Peritonitis: A Review of Treatment Options. Pharmacy and Therapeutics. 2009;34(4):204-210.
2. Fernandez J, Navasa M, Planas R, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007;133:818–824.74. 
3. Terg R, Fassio E, Guevara M, et al. Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: A randomized,placebo-controlled study. J Hepatol 2008;48:774–779.
4. Llach J, Rimola A, Navasa M, et al. Incidence and predictivefactors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: Relevance of ascitic fluid protein concentration. Hepatology. 1992;16:724–727.