Spontaneous Bacterial Peritonitis

Clinical features

  • Abdominal pain
  • Worsening abdominal distension
  • Known chronic liver disease

Investigations

  • Ascitic fluid (in universal container and in blood culture bottles)
  • Blood culture

Infection Control

Basic universal precautions

Treatment

TEMOCILLIN IV 2g 8 hourly 

PLUS

AMOXICILLIN IV 1g 8 hourly 

PLUS

METRONIDAZOLE IV 500mg 8 hourly

 If known / suspected MRSA:

TEMOCILLIN IV 2g 8 hourly 

PLUS

VANCOMYCIN IV (dose as per calculator) 

PLUS

METRONIDAZOLE IV 500mg 8 hourly

If true penicillin allergy:

VANCOMYCIN IV (dose as per calculator) 

PLUS

CIPROFLOXACIN IV 400mg 12 hourly (review MHRA Safety Advice before prescribing)

PLUS

METRONIDAZOLE IV 500mg 8 hourly

 When improving, consider IV to Oral switch as for intra-abdominal sepsis

Duration: 5-7 days in total