Spontaneous bacterial peritonitis

 SPONTANEOUS BACTERIAL PERITONITIS 

(SBP)

Definition:

• SBP is an infection of ascite fluid tha occurs in the absence of a surgically treatable source. 

• SBP of ascites fluid occurs in the absence of on apparent intra- abdominal source of infection. 

RISK FACTOR 

• prior episode of sbp

• ascites total protein <1g/dl

• upper GI haemorrhage

• serum billirubin >2.5mg/dl

• use of PPI 

CLINICAL FEATURES

• fever

• ascites

• bowel sound diminished or absent

• abdominal pain and tender 

• feature of chronic liver disease 

• hepatic encephalopathy

INVESTIGATION 

Ascitic fluid analysis 

         • Cells polymorphs >250/mm^3

         • protein <1gm/dl

         

DIAGNOSTIC CRITERIA

• clinical feature + polymorphs >250/mm^3

• polymorphs >500/ mm^3 without clinical feature

D/D

• Secondary bacterial peritonitis 

• tubercular Peritonitis 

• Peritoneal carcinomatosis 

• pancreatic ascites

TREATMENT

therapeutic antibiotics

  • Third generation cephalosporin

  cefotaxime 1gm iv 8- hourly for 5-7 days 

  • amoxicillin-clavulanic acid 1.2 gm iv 8 - hourly

Prophylactic therapy 

  • Norfloxacin 400mg /day or

  • ciprofloxacin 750mg - weekly or 

  • cortimoxazole 960 mg × daily or 

Prognosis

 • Untreated ; 39% mortality

 • treated early; less than 10% mortality