Spontaneous bacterial peritonitis primary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
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> | 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> | ||
==Primary prevention== | ==Primary prevention== | ||
Revision as of 19:16, 13 June 2014
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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]
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.[1]
Primary prevention
- Prevention of ascites in cirrhosis, heart failure and renal failure.
- Prevention of peritonitis in cases of ascites.
- 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. [2]
- 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.[3][4]
- 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. [5]
References
- ↑ 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.
- ↑ Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002). "Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding". Cochrane database of systematic reviews (Online) (2): CD002907. PMID 12076458.
- ↑ 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.
- ↑ 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.
- ↑ "National Guideline Clearinghouse | Management of adult patients with ascites due to cirrhosis: an update".