Spontaneous Bacterial Peritonitis (Tayside)

Question 1

What investigation is used to look for SBP?

Answer 1

Ascitic tap (RBC, WCC, gm stain, culture, albumin, protein amylase)

Question 2

What would the ascitic tap show that is diagnostic of SBP?

Answer 2

Neutrophil count of >250 cells/mm3
OR
WCC count >250 cells/ mm3 AND ≥90% polymorphs

Question 3

What treatment other than antibiotics is given for SBP?

Answer 3

Drain ascites
IV human albumin solution

Question 4

What is the management of severe SBP (patient is unwell)?

Answer 4

Piperacillin-Tazobactam IV
Co-trimoxazole IV if pen allergic

Question 5

What is the step down management of severe SBP and how long is the total course?

Answer 5

Co-trimoxazole PO
5-7 days

Question 6

If a patient is on prophylactic antibiotics already for SBP and develops severe SBP, should they be stepped down to co-trim?

Answer 6

No
Piperacillin-tazobactam IV full course

Question 7

Management of mild SBP (picked up incidentally on routine tap)?

Answer 7

Co-trimoxazole PO 5-7 days
Ciprofloxacin if co-trimox contraindicated

Question 8

When should SBP prophylaxis be given?

Answer 8

Patient at risk
OR
Finished SBP treatment but still hospital inpatient (stop at end of hospital stay)

Question 9

What is given for SBP prophylaxis?

Answer 9

Co-trimoxazole PO
Ciprofloxacin if contraindicated

Question 10

What is given for infection prophylaxis for patients with cirrhosis and an upper GI bleed?

Answer 10

Co-trimoxazole IV/PO for 5 days
Ciprofloxacin contraindicated