Treatment of spontaneous bacterial peritonitis (SBP) in cirrhosis
| (1) General measures of support |
| Intravenous fluids for dehydration (albumin is preferred as normal saline may exacerbate ascites) |
| Antipyretics |
| Do not use NSAIDs |
| (2) Prevention and/or treatment of complications |
| Hepatic encephalopathy—lactulose |
| Gastrointestinal bleeding—omeprazole/ranitidine |
| Renal dysfunction—albumin infusions, avoid diuretics, avoid nephrotoxic drugs, avoid large volume paracentesis |
| (3) Antibiotics |
| 5 day course of intravenous 3rd generation cephalosporin |
| Ciprofloxacin |
| Amoxicillin/clavulanic acid |
| (4) Assess response to treatment |
| Repeat diagnostic paracentesis in 48 hours |
| (5) Evaluation for liver transplantation |