SPONTANEOUS BACTERIAL PERITONITIS


  • Almost exclusively occurs with ascites
  • Criteria by examination of ascites fluid:
    1. > 500 PMN/mm3 = SBP regardless of sx
    2. 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