Introduction Spontaneous Bacterial Peritonitis (SBP) is the most frequent and life-threatening infection in patients with liver cirrhosis, requiring prompt recognition and treatment. Clinical practise guidelines on management of SBP were released by EASL in 20101 and AASLD in 20092. We wanted to determine if there is uniformity in SBP management in hospitals in Wales, UK.
Methods Invitation to online survey was sent via email link to all WAGE members (Welsh Association for Gastroenterologists and Endoscopists). 25 members responded and results analysed. There were total of 10 questions with focus on diagnosis and drug treatment.
Results 76% of respondents would test for SBP in any cirrhotic ascites including day case routine admissions for therapeutic paracentesis; 12% do not test for day-case asymptomatic patients. 12% test only if presence of sepsis and 4% only if patients are encephalopathic. Only 28% have access to lab polymorphonuclear leucocytes in ascites to confirm SBP; 60% use White Cell Count (WCC) > 250 and 16% use WCC > 500 in ascitic fluid as criteria. Cefotaxime (52%) and Tazocin (32%) were the preferred antibiotic choices with treatment duration ranging between < 5 days (4%), 5–7 days (40%) and > 7 days (56%). Surprisingly, 8 out of 22 respondents (36.3%) do not administer albumin routinely for confirmed SBP but 100% prefer 20% human albumin compared to 4.5% human albumin. There was huge discrepancy in the albumin administration regime between the members. One Consultant gives Terlipressin to all SBP but 24% will consider terlipressin if patients are at high risk of hepatorenal syndrome. 4% routinely repeat diagnostic ascitic tap after 48 hours on SBP treatment while 20% repeat only if infection not settling; 64% do occasionally and 12% ‘never’ repeat. A good 16.7% members do not start prophylactic antibiotics after an episode of SBP but with others, Ciprofloxacin (50%) and Norfloxacin (30%) are favourites. 96% are not in favour of primary antibiotic prophylaxis for ascites with low protein counts. Encouragingly, 45.8% would consider referral for liver transplantation in appropriate patients after an episode of SBP.
Conclusion Even among specialists dealing with chronic liver disease patients day to day, there is wide variation in management of SBP. It is alarming to note that doctors do not believe in secondary prophylaxis and do not administer albumin as part of treatment. There is serious need to standardise treatment and prevent improper management that can cause deterioration in liver function rendering them poor candidates for transplantation.
Disclosure of Interest None Declared
EASL clinical practise guidelines on the management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis. Journal of hepatology 2010 Vol53:397–417
Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087–107
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