SBP
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Intro:
Infection is fairly common (12%)
Diagnosed by:
- Ascitic Fluid PMN count > 250cells/mm3
- Ascitic Fluid C&S +ve
- No evidence of intraabdominal / surgically treatable source of infection (IIryBP)
- LDH < ULN serum
- Glucose >3 mmol/L
Treatment:
- Cefotaxime 2g tds (5-10 days)
- Ceftriaxone 1g bd (Since it is protein bound, there’s a potential limitation to penetrating low protein ascetic fluid?)
- Ofloxacin 400mg bd for 8 days
- Can consider Albumin 1.5g/kg first day and 1g/kg 3rd day. (decrease mortality 30% to 10%), especially in those with creatinine > 88mmol/L, Urea > 5 mmol/L, TB > 68 mmol/L
Differentiation between spontaneous and secondary bacterial peritonitis is in IIryBP:
>250 PMN/mm3
Multiple organism including fungi and enterococcus on culture
TP > 1g/dL
LDH > ULN serum
Glucose <3 mmol/L
Role of repeat paracentesis:
Usually not needed unless response is atypical and high index of suspicion of secondary bacterial peritonitis
Prpphylaxis:
Norfloxacin 400mg daily
Ciporfloxacin 750mg weekly
DS trimethoprim/sulfamethoxazole 5 days a week
Target those who are high risk
TP < 1g/dL (Ascitic Fluid)
Prior episode SBP
Variceal hemorrhage
Creatinine > 88
edited 19th July 2010