Spontaneous bacterial peritonitis

exp date isn't null, but text field is

Peritonitis associated with dialysis

Seek Renal Unit advice. Their guidelines can be found here Edinburgh Renal Unit Antimicrobial Guidance.

Required investigations

Required Investigations:

  • Blood cultures prior to administering antibiotics.
  • Ascitic fluid culture.

Antibiotic Recommendations

Recommended Duration = 5 days (IV + oral)

Antibiotic Recommendation

Piperacillin-tazobactam 4.5g every 8 hours IV


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


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

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


Suitable in penicillin-allergy

Co-trimoxazole 960mg every 12 hours orally


Co-amoxiclav 625mg every 8 hours orally

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


Likely organisms: Gram positive cocci and/or Gram negative coliforms.

  • Discontinue prophylactic antibiotics for duration of treatment.
  • Patients who develop SBP whilst on antibiotic prophylaxis have higher levels of antibiotic-resistance; if ascitic culture is negative continue IV antibiotics for 72 hours before IV to oral switch.
  • If patient not improving at 72 hours then ask for advice here.