SPONTANEOUS BACTERIAL PERITONITIS

SBP is an acute bacterial infection of ascitic fluid. It is a common and severe complication of advanced liver cirrhosis
and it is associated with a poor prognosis.

Clinical features

Patients must be admitted to hospital and should be suspected of SBP infection when:

  • Ascites increases in severity
  • Presence of fever
  • Abdominal pain, abdominal tenderness
  • Worsening encephalopathy
  • Complications: renal failure, bleeding varices, death

Investigations

  • Diagnosis is confirmed by an ascitic tap and cell counts. A neutrophil count of > 250/mm3 in ascitic fluid confirms the diagnosis

Management

  • Treat with IV antibiotics for 5–10 days
  • IV ceftriaxone 1-2 g daily
    • If needed, add metronidazole 500 mg IV every 8 hours
  • Give albumin infusion 1 g/kg to prevent hepatorenal syndrome
  • Consult or refer for specialist care as soon as possible
Caution
  • Avoid gentamicin and NSAIDs