Spontaneous Bacterial Peritonitis

Key points

• SBP: peritonitis in ascites secondary to cirrhosis.
• Diagnosis: paracentesis — ascitic neutrophil count > 250 cells/µl.
• Management: IV cefotaxime usually given.
• Prophylaxis: prior SBP episode; or ascitic protein <15 g/l + Child-Pugh ≥9 or hepatorenal syndrome (NICE: oral ciprofloxacin/norfloxacin until ascites resolves).
• Alcoholic liver disease = poor prognostic marker in SBP.

Decision points in this pathway

• Prophylaxis indicated?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.