Spontaneous bacterial peritonitis primary prevention: Difference between revisions
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* [[Ciprofloxacin]] 500mg PO daily if [[sulfa]] allergic. | * [[Ciprofloxacin]] 500mg PO daily if [[sulfa]] allergic. | ||
* 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><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> | * 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><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><ref name="NovellaSola1997">{{cite journal|last1=Novella|first1=M|last2=Sola|first2=R|last3=Soriano|first3=G|last4=Andreu|first4=M|last5=Gana|first5=J|last6=Ortiz|first6=J|last7=Coll|first7=S|last8=Sabat|first8=M|last9=Vila|first9=M C|last10=Guarner|first10=C|last11=Vilardell|first11=F|title=Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin|journal=Hepatology|volume=25|issue=3|year=1997|pages=532–536|issn=0270-9139|doi=10.1002/hep.510250306}}</ref> | ||
* Primary prophylaxis with [[norfloxacin]] has a great impact in the clinical course of patients with advanced [[cirrhosis]]. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of [[hepatorenal syndrome]], and improves survival.<ref name="FernándezNavasa2007">{{cite journal|last1=Fernández|first1=Javier|last2=Navasa|first2=Miquel|last3=Planas|first3=Ramón|last4=Montoliu|first4=Silvia|last5=Monfort|first5=David|last6=Soriano|first6=German|last7=Vila|first7=Carmen|last8=Pardo|first8=Alberto|last9=Quintero|first9=Enrique|last10=Vargas|first10=Victor|last11=Such|first11=Jose|last12=Ginès|first12=Pere|last13=Arroyo|first13=Vicente|title=Primary Prophylaxis of Spontaneous Bacterial Peritonitis Delays Hepatorenal Syndrome and Improves Survival in Cirrhosis|journal=Gastroenterology|volume=133|issue=3|year=2007|pages=818–824|issn=00165085|doi=10.1053/j.gastro.2007.06.065}}</ref> | * Primary prophylaxis with [[norfloxacin]] has a great impact in the clinical course of patients with advanced [[cirrhosis]]. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of [[hepatorenal syndrome]], and improves survival.<ref name="FernándezNavasa2007">{{cite journal|last1=Fernández|first1=Javier|last2=Navasa|first2=Miquel|last3=Planas|first3=Ramón|last4=Montoliu|first4=Silvia|last5=Monfort|first5=David|last6=Soriano|first6=German|last7=Vila|first7=Carmen|last8=Pardo|first8=Alberto|last9=Quintero|first9=Enrique|last10=Vargas|first10=Victor|last11=Such|first11=Jose|last12=Ginès|first12=Pere|last13=Arroyo|first13=Vicente|title=Primary Prophylaxis of Spontaneous Bacterial Peritonitis Delays Hepatorenal Syndrome and Improves Survival in Cirrhosis|journal=Gastroenterology|volume=133|issue=3|year=2007|pages=818–824|issn=00165085|doi=10.1053/j.gastro.2007.06.065}}</ref> | ||
|}'''General long-term measures''' | |}'''General long-term measures''' |
Revision as of 00:30, 7 February 2017
Spontaneous bacterial peritonitis Microchapters |
Differentiating Spontaneous bacterial peritonitis from other Diseases |
Diagnosis |
Treatment |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Guillermo Rodriguez Nava, M.D. [3] Shivani Chaparala M.B.B.S [4]
Overview
As most episodes of spontaneous bacterial peritonitis (SBP) are thought to result from bacterial translocation from the gut. Given the risk of resistance and alteration of gut flora, long-term antibiotic prophylaxis should be reserved for high-risk patients only.[1]
Primary prevention
Because of high risk of resistance and alteration of gut flora, long-term antibiotic prophylaxis should be reserved for high-risk patients with:[2]
- Cirrhotic patients with ascitic fluid total protein less than 1.0 g/dL,
- Variceal hemorrhage, and a
- Prior episode of SBP.
A variety of randomized controlled trials of prophylactic antibiotics in patients with ascites have shown a benefit for the prevention of development of SBP.
The AASLD guidelines suggest using long-term antibiotic prophylaxis for SBP in patients who have the following risk factors:[3][4]
Ascitic fluid total protein less than 1.5 g/dL and at least one of the following:
- Serum creatinine greater than or equal to 1.2 mg/dL,
- Blood urea nitrogen greater than or equal to 25 mg/dL,
- Serum sodium less than or equal to 130 mEq/L, or
- Child-Turcotte-Pugh greater than or equal to 9 points (with bilirubin greater than or equal to 3 mg/dL).[3][4]
Specific measures for high-risk cases
Cirrhotic patients with gastrointestinal hemorrhage | Non-bleeding cirrhotic patients with ascites |
---|---|
|
|
General long-term measures
- Abstinence from alcohol.
- Improvement in nutrition and general status of the patient.
- Aggressive treatment and eradication of localized infections before dissemination.
- 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.
- 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.[11]
References
- ↑ Alaniz C, Regal RE (2009). "Spontaneous bacterial peritonitis: a review of treatment options". P T. 34 (4): 204–10. PMC 2697093. PMID 19561863.
- ↑ Runyon BA, AASLD Practice Guidelines Committee (2009). "Management of adult patients with ascites due to cirrhosis: an update". Hepatology. 49 (6): 2087–107. doi:10.1002/hep.22853. PMID 19475696.
- ↑ 3.0 3.1 Fernández J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G; et al. (2007). "Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis". Gastroenterology. 133 (3): 818–24. doi:10.1053/j.gastro.2007.06.065. PMID 17854593.
- ↑ 4.0 4.1 Novella M, Solà R, Soriano G, Andreu M, Gana J, Ortiz J; et al. (1997). "Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin". Hepatology. 25 (3): 532–6. doi:10.1002/hep.510250306. PMID 9049193.
- ↑ Bernard, Brigitte; Grangé, Jean-Didier; Khac, Eric Nguyen; Amiot, Xavier; Opolon, Pierre; Poynard, Thierry (1999). "Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis". Hepatology. 29 (6): 1655–1661. doi:10.1002/hep.510290608. ISSN 0270-9139.
- ↑ Singh N, Gayowski T, Yu VL, Wagener MM (1995). "Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial". Ann Intern Med. 122 (8): 595–8. PMID 7887554.
- ↑ Fernández, J (2002). "Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis". Hepatology. 35 (1): 140–148. doi:10.1053/jhep.2002.30082. ISSN 0270-9139.
- ↑ "National Guideline Clearinghouse | Management of adult patients with ascites due to cirrhosis: an update".
- ↑ Novella, M; Sola, R; Soriano, G; Andreu, M; Gana, J; Ortiz, J; Coll, S; Sabat, M; Vila, M C; Guarner, C; Vilardell, F (1997). "Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin". Hepatology. 25 (3): 532–536. doi:10.1002/hep.510250306. ISSN 0270-9139.
- ↑ Such J, Runyon BA (1998). "Spontaneous bacterial peritonitis". Clin Infect Dis. 27 (4): 669–74, quiz 675-6. PMID 9798013.