Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 44: My Patient With Cryptogenic Cirrhosis Was Recently Hospitalized With Spontaneous Bacterial Peritonitis. How Long Should She Be Treated With Antibiotics? (continued)

Paul Arnold, MD; Adil Habib, MD; Douglas M. Heuman, MD

Spontaneous bacterial peritonitis (SBP) is a potentially lethal infection in the cirrhotic patient. It should be sought aggressively and treated early with effective antibiotics. The duration of treatment is dictated by the results of cultures, severity of illness, and clinical response to therapy. Any patient who has experienced SBP is at high risk to recur and should receive long-term prophylactic antibiotic therapy for as long as ascites persists. SBP occurs commonly in the setting of cirrhotic ascites. Two pathophysiological factors are at work.1 First, cirrhotic ascites fluid is a good…