Required Investigations:
- Blood cultures prior to administering antibiotics.
- Ascitic fluid culture.
Spontaneous bacterial peritonitis
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Peritonitis associated with dialysis
Seek Renal Unit advice. Their guidelines can be found here Edinburgh Renal Unit Antimicrobial Guidance.
Recommended Duration = 5 days (IV + oral)
| Antibiotic Recommendation |
Piperacillin-tazobactam 4.5g every 8 hours IV |
| Penicillin-allergy |
Vancomycin (use NHS Lothian Calculator located on AMT intranet page) - target trough level 15-20mg/L PLUS 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.
|
Preferred Suitable in penicillin-allergy |
Co-trimoxazole 960mg every 12 hours orally |
| Alternative |
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.