Spontaneous bacterial peritonitis (SBP) is a risky complication
that occurs amongst cirrhotic patients with ascites. SBP
develops in approximately 10 to 30% and has an estimated inhospital
mortality rate of 20%. SBP outcomes from translocation
of bacteria from the intestinal lumen. Also, SBP results from a
bacteremia that initiates at a distant site, such as a urinary
tract infection. The majority of cases of SBP are produced by
gram-negative enteric organisms, such as Escherichia coli and
Klebsiella pneumonia. Third-generation, broad-spectrum cephalosporins
continue a good initial choice for SBP treatment.
Levofloxacin is an acceptable alternative for patients not
receiving long-term flouroquinolone prophylaxis or for those with
a penicillin allergy. Different antibiotics such as pipercillintazobactam
should be considered for patients with nosocomial
SBP or for patients who fail to improve on traditional antibiotic
regimens.