Spontaneous Bacterial Peritonitis
Antimicrobial prescribing: NHS Fife
Clinical features
- Abdominal pain
- Worsening abdominal distension
- Known chronic liver disease
Investigations
- Ascitic fluid (in universal container and in blood culture bottles)
- Blood culture
Infection Control
Basic universal precautions
Treatment
TEMOCILLIN IV 2g 8 hourly
PLUS
AMOXICILLIN IV 1g 8 hourly
PLUS
METRONIDAZOLE PO 400mg 8 hourly
(Metronidazole may instead be given intravenously 500mg 8 hourly if the oral route is unavailable)
If known / suspected MRSA:
TEMOCILLIN IV 2g 8 hourly
PLUS
VANCOMYCIN IV (dose as per calculator)
PLUS
METRONIDAZOLE PO 400mg 8 hourly
(Metronidazole may instead be given intravenously 500mg 8 hourly if the oral route is unavailable)
If true penicillin allergy:
TIGECYCLINE* IV 100mg initially, followed by 50mg 12 hourly
*TIGECYCLINE is usually a protected antibiotic but can be accessed without restriction for this indication only.
When improving, consider IV to Oral switch as for intra-abdominal sepsis
Duration: 5 days in total (IV+Oral)