Table 3.

 Treatment of spontaneous bacterial peritonitis (SBP) in cirrhosis

(1) General measures of support

Intravenous fluids for dehydration (albumin is preferred as normal saline may exacerbate ascites)

Antipyretics

Do not use NSAIDs

(2) Prevention and/or treatment of complications

Hepatic encephalopathy—lactulose

Gastrointestinal bleeding—omeprazole/ranitidine

Renal dysfunction—albumin infusions, avoid diuretics, avoid nephrotoxic drugs, avoid large volume paracentesis

(3) Antibiotics

5 day course of intravenous 3rd generation cephalosporin

Ciprofloxacin

Amoxicillin/clavulanic acid

(4) Assess response to treatment

Repeat diagnostic paracentesis in 48 hours

(5) Evaluation for liver transplantation