| Spontaneous bacterial peritonitis | |
|---|---|
| Classification and external resources | |
| ICD-9 | 567.23 |
| eMedicine | emerg/882 |
Spontaneous bacterial peritonitis (SBP) (a.k.a. primary peritonitis) is a form of peritonitis that occurs in patients with cirrhosis and children with nephrotic syndrome. It occurs in 10-30% of hospitalized patients with ascites, and can cause marked decompensation of the liver disease, with other complications and death occurring frequently.
Contents |
Symptoms include fevers, chills, nausea, vomiting, abdominal tenderness and general malaise. Patients may complain of abdominal pain and worsening ascites. Hepatic encephalopathy may be the only manifestation of SBP; in the absence of a clear precipitant for the encephalopathy, all patients should undergo paracentesis, or sampling of the ascites fluid, in order to assess for SBP.
Diagnosis necessitates paracentesis (needle drainage of the ascitic fluid) and laboratory confirmation of ascitic neutrophils > 250/mm³.
After confirmation of SBP, patients need hospital admission for intravenous antibiotics (most often cefotaxime 2g IV Q8-12H for at least 5 days or ceftriaxone 2g IV Q24H). They will often also receive intravenous albumin. A repeat paracentesis in 48 hours is sometimes performed to ensure control of infection. Once patients have recovered from SBP, they require regular prophylactic antibiotics (e.g. Septra DS 1 tab 5 times/week, Ciprofloxacin 750mg PO Q1W, norfloxacin 400mg Q24H) as long as they still have ascites.
A randomized controlled trial found that intravenous albumin on the day of admission and on hospital day 3 can reduce renal impairment.[1]
All cirrhotic patients might benefit from antibiotics if:
Cirrhotic patients admitted to the hospital should receive antibiotics if:
|
|