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| __NOTOC__ | | __NOTOC__ |
| {{Spontaneous bacterial peritonitis}} | | {{Spontaneous bacterial peritonitis}} |
| {{CMG}}; {{AE}} {{ADI}} {{GRN}} {{SCh}} | | {{CMG}}; {{AE}} {{SCh}}{{AY}} |
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| ==Overview== | | ==Overview== |
| A variety of randomized controlled trials of prophylactic antibiotics in patients with ascites have shown a benefit for the prevention of development of SBP. Patients with ascitic fluid protein concentration <1.0 g/dL, variceal hemorrhage, and prior episode of SBP should receive antibiotic prophylaxis.<ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696 }} </ref>
| | No [[primary prevention]] described for SBP but early diagnosis and initiating [[Antibiotic|empiric antibiotic treatment]] is crucial for improving the prognosis. |
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| ==Primary prevention== | | ==Primary prevention== |
| ==='''General long-term measures'''===
| | No [[primary prevention]] described for SBP but early diagnosis and initiating [[Antibiotic|empiric antibiotic treatment]] is crucial for improving the prognosis. |
| * Abstinence from alcohol
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| * Improvement in nutrition and general status of the patient
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| * Aggressive treatment and eradication of localized infections before dissemination
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| * Measures directed at reducing the risk of gastrointestinal bleeding or the development of ascites, like surgical portacaval shunts or trans-jugular intrahepatic portasystemic stent-shunts, may help prevent SBP
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| * Diuretic therapy decreases the AF volume and has been shown to significantly increase the AF opsonic activity, theoretically helping to prevent the development of SBP.<ref name="pmid9798013">{{cite journal| author=Such J, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 669-74; quiz 675-6 | pmid=9798013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798013 }} </ref>
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| * '''Cirrhotic patients with gastrointestinal hemorrhage'''
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| ** Ciprofloxacin 500mg PO BID X 7days<ref name="BernardGrangé1999">{{cite journal|last1=Bernard|first1=Brigitte|last2=Grangé|first2=Jean-Didier|last3=Khac|first3=Eric Nguyen|last4=Amiot|first4=Xavier|last5=Opolon|first5=Pierre|last6=Poynard|first6=Thierry|title=Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis|journal=Hepatology|volume=29|issue=6|year=1999|pages=1655–1661|issn=02709139|doi=10.1002/hep.510290608}}</ref>
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| ** If the patients is NPO Ceftriaxone 1 g IV Q24H can be used
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| ** Switch to Ciprofloxacin 500 mg PO BID once bleeding is controlled
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| * '''Non-bleeding cirrhotic patients with ascites'''
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| ** TMP/SMX 1 DS PO once daily or
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| ** Ciprofloxacin 500mg PO daily if sulfa allergic
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| * All patients with Cirrhosis and upper GI bleeding should receive prophylaxis x 7 days since 50% of the patients develop ascites after the bleed.
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| * Prophylaxis should be considered for those with low protein concentration in ascites (< 10 g/L) or immunosuppression while the patient is at hospital.
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| * General measures to improve the patient’s overall medical condition such as abstinence from alcohol and improvement in nutritional status should be attempted.
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| * Reduction in the volume of ascites using diuretic therapy has been demonstrated to increase the ascitic fluid total protein level and should theoretically decrease the risk of infection by way of higher opsonic activity.<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324 }} </ref>
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| * Screening for and prophylaxis of esophageal varices to reduce the risk of gastrointestinal hemorrhage are also recommended
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| * Prevention of ascites in [[cirrhosis]], [[heart failure]] and [[renal failure]].
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| * Prevention of [[peritonitis]] in cases of [[ascites]].
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| * Intravenous [[ceftriaxone]] for 7 days or twice-daily norfloxacin for 7 days should be given to prevent [[bacterial infections]] in patients with [[cirrhosis]] and [[gastrointestinal hemorrhage]]. <ref name="pmid12076458">{{cite journal |author=Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L |title=Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD002907 |year=2002 |pmid=12076458 |doi=}}</ref>
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| *Patients with cirrhosis and ascites but no gastrointestinal hemorrhage, long-term use of [[norfloxacin]] can be considered if the ascitic fluid protein <1.5 g/dL and one or more of the following are present: serum creatinine >1.2 mg/dL, blood urea nitrogen >25 mg/dL, serum sodium <130 mEq/L or Child-Pugh >9 points with bilirubin >3 mg/dL.<ref name="pmid17854593">{{cite journal| author=Fernández J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G et al.| title=Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. | journal=Gastroenterology | year= 2007 | volume= 133 | issue= 3 | pages= 818-24 | pmid=17854593 | doi=10.1053/j.gastro.2007.06.065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17854593 }} </ref><ref name="pmid9049193">{{cite journal| author=Novella M, Solà R, Soriano G, Andreu M, Gana J, Ortiz J et al.| title=Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. | journal=Hepatology | year= 1997 | volume= 25 | issue= 3 | pages= 532-6 | pmid=9049193 | doi=10.1002/hep.510250306 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9049193 }} </ref>
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| * Intermittent dosing of antibiotics to prevent bacterial infections may be inferior to daily dosing (due to the development of bacterial resistance) and thus daily dosing should preferentially be used.<ref name="Fernández2002">{{cite journal|last1=Fernández|first1=J|title=Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis|journal=Hepatology|volume=35|issue=1|year=2002|pages=140–148|issn=02709139|doi=10.1053/jhep.2002.30082}}</ref>
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| <ref name="urlNational Guideline Clearinghouse | Management of adult patients with ascites due to cirrhosis: an update.">{{cite web |url=http://guideline.gov/content.aspx?id=14887&search=ascitis |title=National Guideline Clearinghouse | Management of adult patients with ascites due to cirrhosis: an update. |format= |work= |accessdate=}}</ref>
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| {{WS}}
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| | [[Category:Emergency mdicine]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |