How do you rule out spontaneous bacterial peritonitis?

The diagnosis of SBP is established based on positive ascitic fluid bacterial cultures and the detection of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count in the ascites (>250/mm3) without an evident intra-abdominal surgically treatable source of infection [1, 9].

What is the most appropriate management concerning the risk of spontaneous bacterial peritonitis?

Patients with SBP should be started on empiric, broad-spectrum antibiotics immediately after peritoneal fluid is obtained. When culture results are available, antibiotic coverage can be tailored to cover the specific organisms identified. (See “Spontaneous bacterial peritonitis in adults: Diagnosis”.)

Can you do LVP with SBP?

Large volume paracentesis (LVP) is the standard treatment for tense ascites. LVP is historically avoided in patients with SBP due to the potential risk of circulatory dysfunction. These are based on presumed physiologic mechanisms and have not been adequately studied with robust clinical outcomes.

How long do you treat spontaneous bacterial peritonitis?

For spontaneous bacterial peritonitis (SBP), a 10- to 14-day course of antibiotics is recommended. Although not required, a repeat peritoneal fluid analysis is recommended to verify declining PMN counts and sterilization of ascitic fluid.

How do you calculate PMN?

The absolute PMN count is calculated by multiplying the total white blood cell count (or total “nucleated cell” count) by the percentage of PMNs in the differential. The cell count and differential are performed manually without formal quality control.

How do you interpret ascitic fluid in SBP?

A high SAAG (>1.1g/dL) suggests the ascitic fluid is a transudate. A low SAAG (<1.1g/dL) suggests the ascitic fluid is an exudate.

What is the most common cause of spontaneous bacterial peritonitis?

The most common bacteria causing SBP are gram-negative Escherichia coli and Klebsiella pneumoniae and gram-positive Streptococcus pneumoniae; usually only a single organism is involved.

How do you treat SBP?

The empirical treatment of SBP consists of any of a number of cephalosporins, such as cefotaxime (Claforan), ceftriaxone (Rocephin), ceftizoxime (Cefizox), or amoxicillin–clavulanic acid (e.g., an IV formulation in Europe). Because the relative efficacy of these agents is similar, cost should be the mitigating factor.

Why is spironolactone used in ascites?

5.5. Spironolactone is an aldosterone antagonist, acting mainly on the distal tubules to increase natriuresis and conserve potassium. Spironolactone is the drug of choice in the initial treatment of ascites due to cirrhosis.

Is SBP curable?

Spontaneous bacterial peritonitis (SBP) is the infection of ascitic fluid in the absence of any intra‐abdominal, surgically treatable source of infection. Despite timely diagnosis and treatment its reported incidence in ascitic patients varies between 7–30%.

Can you treat SBP with oral antibiotics?

Consequently, cefotaxime at a dose of 2 g every 12 hours was more cost-effective for treating SBP. In addition, the use of oral antibiotic therapy, namely ofloxacin (Floxin, PriCara) 400 mg every 12 hours, was recommended for patients with uncomplicated SBP who had not previously received quinolone prophylaxis.