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| __NOTOC__ | | __NOTOC__ |
| {{Spontaneous bacterial peritonitis}} | | {{Spontaneous bacterial peritonitis}} |
| {{CMG}}; {{AE}} {{ADI}} {{GRN}} | | {{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== |
| * Prevention of ascites in [[cirrhosis]], [[heart failure]] and [[renal failure]].
| | No [[primary prevention]] described for SBP but early diagnosis and initiating [[Antibiotic|empiric antibiotic treatment]] is crucial for improving the prognosis. |
| * 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="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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| {{WH}}
| | [[Category:Gastroenterology]] |
| {{WS}}
| | [[Category:Emergency medicine]] |
| | | [[Category:Emergency mdicine]] |
| [[Category:Grammar]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |