Treatment of Spontaneous Bacterial Peritonitis

After the diagnosis of spontaneous bacterial peritonitis (SBP), patients should immediately receive empiric antibiotic treatment. Until the results of susceptibility testing are available, broad-spectrum therapy is warranted in patients with a suspected ascitic fluid infection. A reasonable choice for suspected SBP is a third-generation cephalosporin, preferably cefotaxime 2 g every 8 h. In uncomplicated SBP, oral ofloxacin (400 mg twice per day for an average of 8 days) also provides similar results as intravenous cefotaxime. Intravenous albumin infusions can also decrease the risk of renal impairment that often develops in patients with SBP. Several randomized controlled trials have reported that the administration of antibiotic prophylaxis in high-risk SBP patients can decrease the risk of bacterial infection and mortality. However, in order to minimize bacterial resistance, it is necessary to restrict the use of these prophylactic antibiotics to patients who demonstrate the well-defined criteria for SBP prophylaxis.