Important: Therapy
Temocillin 2g IV every 8 hours
plus Amoxicillin 1g IV every 8 hours
Spontaneous Bacterial Peritonitis (SBP)
Duration
total (IV plus PO) up to 10 days
Important: Therapy
If the patient has not received SBP prophylaxis with Norfloxacin or another quinolone agent:
Ciprofloxacin PO 500mg every 12 hours or IV 400mg every 12 hours
plus Vancomycin IV as per Vancomycin Pulsed Infusion Dosage Guidelines or Vancomycin Continuous Infusion Dosage Guidelines
Notes:
If the patient has received SBP prophylaxis with norfloxacin or another quinolone agent, please discuss antimicrobial therapy with an Infection Specialist.
Important: Therapy
Co-trimoxazole 960mg orally once daily
Important: Notes
When performing an ascitic tap, always send fluid in a universal (white top) container, as the laboratory is unable to perform cell counts on ascitic fluid injected into blood culture bottles, and gram staining is only done once the culture flags positive.
Amoxicillin provides cover for streptococci of the group formerly known as "Strep milleri", which are always amoxicillin susceptible and for enterococci (amoxicillin resistance rates <10%). It provides no reliable cover for E.coli (70% of bloodstream isolates are resistant). Klebsiella species are always amoxicillin resistant.
Gentamicin is contra-indicated in decompensated Alcoholic Liver Disease as it is thought to increase the risk of hepato-renal syndrome. Temocillin resistance in enterobacteriaceae from abdominal samples is low at around 9%. Please note this is a low risk off label use of this agent.
Ciprofloxacin resistance in the same isolates is higher (20%), and patient on long-term quinolone SBP prophylaxis are at particular risk.