Spontaneous Bacterial Peritonitis- Investigations:

A diagnostic paracentesis is mandatory in all cirrhotic patients with ascites requiring hospital admission.

• Inject ascites fluid into FBC count bottle (lavender EDTA bottle) and send to haematology. Ask for WCC and neutrophils. This should be an urgent request and results should be followed up.
  • An Ascitic fluid WCC of >0.5 x 10⁹/L (> 500 cells/mm³) or neutrophil count of >0.25 x 10⁹/L ( >250 cells/mm³) is diagnostic for SBP and treatment should be initiated.
   
• Ascitic fluid should be inoculated into a sterile universal container and sent to microbiology for culture and into blood culture bottles at the bedside and sent to microbiology for culture. 
• DO NOT request glucose and lactate estimation in ascitic fluid routinely.
  

The Full Guideline "Antibiotic Guidelines for Adult Patients with Spontaneous Bacterial Peritonitis or Liver Cirrhosis with Upper Gastrointestinal Bleed." is available here. 

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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