by Nicole Evans M.D.

Created on: February 13, 2010   Last Updated: February 15, 2010

Spontaneous bacterial peritonitis is an infectious condition that occurs specifically in individuals with ascites. Ascites is the term used to describe abnormal fluid accumulation in the peritoneal cavity. The peritoneal cavity is the space between your internal abdominal organs and your muscular abdominal wall. 

Ascites occurs in people who have chronic liver failure. Most medical professionals will refer to chronic liver failure as cirrhosis. The most common cause of cirrhosis is drinking too much alcohol. Other common causes of cirrhosis are infection with the viruses Hepatitis B and/or Hepatitis C.

Some people may develop cirrhosis simply from being obese, while other people develop liver failure from excess iron or copper deposition in their liver.

When someone has chronic liver failure and develops even a small amount of ascites, they are at risk of developing spontaneous bacterial peritonitis.  Symptoms of spontaneous bacterial peritonitis in patients with liver failure include:

-Fevers and chills

-Nausea and vomiting

-Abdominal tenderness to palpation and abdominal pain

-Diarrhea

-Fatigue

-Jaundice (yellow skin and/or eyes)

-Joint pain

Spontaneous bacterial peritonitis is diagnosed by examination of the ascitic fluid that is withdrawn during paracentesis. Patients with ascitic fluid polymorphonuclear leukocyte (PMNL) counts of 250 cells per mm3 or greater should receive empiric antibiotic therapy. 

Patients with ascitic fluid PMNL counts less than 250 cells per mm3, but who have signs and symptoms of infection should receive empiric antibiotic therapy as well.

Empiric therapy means that the person is treated for an infection before it is proven, via culture of the fluid, that an infection is actually present. The antibiotic often used for empiric treatment of spontaneous bacterial peritonitis, or SBP, is cefotaxime [Claforan] 2 g intravenously every eight hours. 

Patients are also often given albumin in the amount of 1.5 g per kg body weight within six hours of detection, as well as 1 g per kg of albumin on day 3 after initial albumin infusion. The albumin is given to prevent spontaneous bacterial peritonitis in patients with ascites.

If a patient cannot receive IV cefotaxime, the oral alternative is ofloxacin (Floxin) at 400 mg twice daily. Ofloxacin is used as an alternative to intravenous medications only in cirrhotic patients without vomiting, shock, severe hepatic encephalopathy, or a creatinine level greater than 3 mg per dL.

Many people survive their first episode of spontaneous bacterial peritonitis.  These people should then receive long-term antibiotics such as Bactrim or Septra to prevent future episodes of SBP.

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