Spontaneous bacterial peritonitis | Right Decisions

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

For peritonitis associated with dialysis refer to: Edinburgh Renal Unit Antimicrobial Guidance.

Required investigations

Blood cultures prior to administering antibiotics.
Paracentesis should be carried out without delay. Diagnosis confirmed by:

WCC > 500 X 10⁶/L
Positive ascitic fluid culture with clinical signs of infection

Antibiotic recommendations

Piperacillin-tazobactam 4.5g every 8 hours IV

Known MRSA carriage:

Piperacillin-tazobactam 4.5g every 8 hours IV

PLUS

Vancomycin IV (use NHS Lothian Calculator located on AMT intranet page)- target trough level 15-20mg/L

Penicillin allergy:

Vancomycin IV (use NHS Lothian Calculator located on AMT intranet page) - target trough level 15-20mg/L

PLUS

Ciprofloxacin 500mg every 12 hours orally (or 400mg every 12 hours IV)

See MHRA fluoroquinolone guidance here.

Piperacillin-tazobactam and ciprofloxacin are associated with C.diff infection. See here for risk factors for C.diff infection.

IV to oral switch

Recommended total duration: 5 days (total duration = IV + oral)

Review patient in 48 hours. If clinically improving, consider IV to oral switch
This should be based on culture results when available. Otherwise empirical cover as below:

Preferred:

Co-trimoxazole 960mg every 12 hours orally (suitable in penicillin allergy)

Alternative:

Co-amoxiclav 625mg every 8 hours orally

Suitable for those ≤ 65 years old. See prevention of Cdiff infection.

Notes

Likely organisms: Gram positive cocci and/or Gram negative coliforms.
Culture results may be negative in patients taking prophylactic antibiotics