Spontaneous bacterial peritonitis (SBP) is a form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.

It may present atypically (often with no abdominal tenderness or guarding) and should be suspected in patients who deteriorate suddenly with no other obvious cause.

PC

• ascites
• abdominal pain
• fever

Investigations

• paracentesis: neutrophil count > 250 cells/ul
  • the most common organism found on ascitic fluid culture is E. coli
  • patients should have an ascitic tap within 8 hours of clinical suspicion

Management

• intravenous cefotaxime, ceftriaxone, ciproflaxacin is usually given
  • if an ascitic tap cannot be performed, empirical antibiotic therapy should not be delayed

Antibiotic prophylaxis should be given to patients with ascites if:

• patients who have had an episode of SBP
• patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
• NICE recommend: 'Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved'

Alcoholic liver disease is a marker of poor prognosis in SBP.