Patient handout

Spontaneous Bacterial Peritonitis

PRODUCTION

1. Your condition

This handout is for spontaneous bacterial peritonitis. Your care team identified this based on: fever, chills, or abdominal pain in cirrhotic with ascites (aasld 2021).

Other reasons your team may use this plan: new or worsening encephalopathy in cirrhotic with ascites (aasld 2021); new aki in cirrhotic with ascites (aasld 2021); any admission of cirrhotic with ascites - mandatory diagnostic paracentesis (aasld 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ceftriaxone	2 g IV daily x 5-7 days	IV	daily	AASLD 2021 first-line for community-acquired SBP (PMID 33942342); narrower than cefotaxime per current resistance patterns
cefotaxime	2 g IV q8h x 5-7 days	IV	q8h	Original Sort 1999 regimen (PMID 10432325); equivalent to ceftriaxone

Plan: SBP - empiric ceftriaxone + albumin (if Sort criteria) + secondary prophylaxis (AASLD 2021; Sort 1999; Fernandez 2007)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Ascitic PMN >=250/mm^3 in cirrhotic with ascites (AASLD 2021)
SBP + (Cr >1.0 mg/dL OR BUN >30 mg/dL OR total bilirubin >4 mg/dL) (Sort 1999)
MAP <65 despite 20-30 mL/kg fluids OR lactate >4 mmol/L in SBP (Surviving Sepsis 2021)(life-threatening)
SBP onset >=48h post-admission OR on quinolone prophylaxis OR recent healthcare exposure (AASLD 2021)
Second or more SBP episode (AASLD 2021)
Runyon criteria - any 2 of (ascitic glucose <50, LDH > serum upper limit, total protein >1 g/dL, polymicrobial gram stain) (AASLD 2021)(life-threatening)

5. Follow-up

Secondary prophylaxis NORFLOXACIN 400 mg PO daily (or ciprofloxacin 500 mg daily or TMP/SMX DS daily) lifelong or until transplant (Fernandez 2007 PMID 17854593); transplant evaluation; HCC surveillance; hepatology q1-3mo (AASLD 2021)

6. Sources

Guideline: AASLD 2021 Practice Guidance: Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome (Biggins, Hepatology 2021)