Gastroenterology Book

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Spontaneous Bacterial Peritonitis

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  1. Etiologies
    1. Escherichia coli
    2. Klebsiella
    3. Streptococcus Pneumoniae
    4. Enterococcus faecalis
  2. Signs (variably present)
    1. Generalized Abdominal Pain with rebound
    2. Fever
    3. Chills
    4. Leukocytosis
  3. Diagnosis: Ascitic Fluid by Paracentesis
    1. Ascitic Fluid Culture: often negative
    2. Neutrophils (PMNs) > 250/mm3
    3. Leukocytes > 500/mm3
  4. Management: Empiric antibiotics
    1. Start immediately (high mortality rate)
    2. Duration: 10-14 days
    3. Parenteral antibiotics
      1. Cefotaxime 2 grams every 8 hours
    4. Oral antibiotics
      1. Ofloxacin 400 mg PO bid
      2. Indications for oral therapy
        1. Tolerating oral (no Vomiting)
        2. No shock or severe Hepatic Encephalopathy
        3. Serum Creatinine <3 mg/dl
      3. Spanish Study (n=123)
        1. Stable patients with SBP treated for 7 days
        2. Cipro PO as effective as Cefotaxime IV (84%)
        3. Navasa (1996) Gastroenterology 111:1011
  5. Management: Adjunctive
    1. Give albumin IV within 6 hours of diagnosis
    2. Dosing
      1. Dose 1: Albumin 1.5 gram/kg body weight initially
      2. Dose 2: Albumin 1 gram/kg on day 3
  6. Prevention
    1. Indications: Survivors of prior SBP episode
    2. Long-term prophylactic antibiotics
      1. Norfloxacin
      2. Trimethoprim-sulfamethoxazole (Septra)
  7. References
    1. Runyon (2004) Hepatology 39:841

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