Spontaneous Bacterial Peritonitis- Antibiotic treatment:

Initial treatment in severe disease:

Piperacillin/tazobactam IV 4.5g TDS (N.B. contains a penicillin)

Mild penicillin allergy (e.g. rash only)

Cefuroxime IV 1.5g TDS +/- Metronidazole PO 400mg TDS

Severe penicillin allergy/allergic to cephalosporins

Ciprofloxacin PO 500mg BD (discuss with microbiology if the oral route is not available) plus Vancomycin IV 1g BD (adjust dose if >65 yrs or renal impairment) [monitor levels] +/- Metronidazole PO 400mg TDS.  As  ciprofloxacin can increase selection for C.difficile infection and MRSA colonisation/infection, all patients with previous MRSA/C.difficile  require microbiology approval to use ciprofloxacin.

Mild disease/Oral continuation treatment from severe above:
(NB see IV to PO switch guideline on the antibiotic website)

Co-trimoxazole PO 960mg BD (Reduce dose to 480mg BD if CrCl <30ml/min)

Allergic to sulphonamides, trimethoprim or Co-trimoxazole(Septrin®): Discuss with medical microbiologist/gastroenterologist

All patients who have recovered from one previous episode of SBP should be offered prophylaxis

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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