SPONTANEOUS BACTERIAL PERITONITIS
Almost exclusively occurs with ascites
Criteria by examination of ascites fluid:
- > 500 PMN/mm3 = SBP regardless of sx
- 250-500 PMN/mm3 should be treated presumptively
if symptomatic; if not, repeat paracentesis in
24-48h
Empiric tx with Cefotaxime may cause less nephrotoxicity
than traditional amp/gent
Oral ofloxacin (100-800mg/d, depending on renal function)
produced identical resolution rates as IV cefotaxime in
123 pts with cirrhosis and SBP and without shock, GI
bleed, Cr > 3.0, or grade II-IV hepativ encephalopathy
(Gastroent. 111:1011, 1996-JW)
Secondary prophylaxis with norfloxacin may reduce
recurrences but may not reduce mortality
Addition of IV Albumin (1.5g/kg at time
of dx and 1g/kg on day 3) to cefotaxime resulted in RR
0.3 for renal impairment and 0.33 for in-hospital
mortality (NEJM 341:403, 1999--JW)
Source: AFP summary of Mayo Clin. Proc. 70:365, 1995