Exam III: SBP

Question 1

What are the most common etiological agents of SBP?

Answer 1

Gram Negative = E. coli or K. pneumonia

Gram + = S. pneumo or S. aureus

Question 2

How do we formally diagnose SBP?

Answer 2

SBP + measures the absolute polymorphonuclear count. (>250= SBP)

Question 3

A polymorphonuclear count above _____ in the ascitic fluid is indicative of SBP.

Answer 3

250

Question 4

How do you calculate Absolute Polymorphonuclear count

Answer 4

WBC * % polymorphonuclear leukocytes.

Question 5

Why do we treat regardless of bacterial culture results for suspected cases of SBP?

Answer 5

Often false negative due to prior treatment with antibiotics.

Question 6

How long do we treat with antibiotics for SBP?

Answer 6

5 days. (longer does not have better outcomes.)

Question 7

What is our preferred agent to treat SBP?

Answer 7

3rd Generation Cephalosporins (Cefotaxime or Ceftraixone)

Question 8

What do we use to treat SBP if 3rd gen cephalosporins can not be used?

Answer 8

Ciprofloxacin IV

Question 9

After 48-72 hours we should streamline therapy to the etiological agent if known. This is known as ______.

Answer 9

Pathogen Directed Therapy

Question 10

When should you use IV albumin for SBP?

Answer 10

SCR >1
Bili >4
BUN > 30

Question 11

If IV albumin 25% is used for SBP, what is the dosage?

Answer 11

1.5 grams/kg on day 1, then 1 gram/kg on day 3.

Question 12

What are the indications for SBP prophylaxis?

Answer 12

1. Variceal Bleeding (treat 7 days)
2. SBP history —> indefinite prophylaxis
3. Ascites Protein <1.5 g/dL + one of the following —> SCR >1.2 | BUN 25+ | Na <130 | Child-Pugh 9+ | Bilirubin 3+

Question 13

What agents are used for SBP prophylaxis indefinitely?

Answer 13

1. Norfloxacin 400 mg QD
2. Ciprofloxacin 750 QW (250-500 QD)
3. Bactrim DS Tab QD