Spontaneous Bacterial Peritonitis Organism-Specific Therapy

Updated: Feb 14, 2023
  • Author: Bruce M Lo, MD, MBA, RDMS, FACEP, FAAEM, FACHE, FAAPL, CPE; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Common organisms in spontaneous bacterial peritonitis (SBP) and treatment recommendations for these organisms are provided below, as well as special considerations. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]

Common organisms in spontaneous bacterial peritonitis

Escherichia coli

Klebsiella pneumoniae

Streptococcus pneumoniae

Enterococcus species

Treatment recommendations for E coli, K pneumoniae, and S pneumoniae

Cefotaxime 2 g IV q8h for 5 d or

Ofloxacin 400 mg PO q12h for 5 d

Treatment recommendations for resistant E coli or Klebsiella spp

Doripenem 500 mg IV q8h or

Ertapenem 1 g IV q24h or

Imipenem 0.5-1 g IV q6h or

Meropenem 1 g IV q8h or

Ciprofloxacin 400 mg IV q12h or

Moxifloxacin 400 mg IV q24h

Duration of therapy is unclear; however, treatment for 5 days has shown success; 2 weeks is recommended if blood cultures are positive.

Treatment recommendations for Enterococcus spp

Ampicillin 1-2 g IV q4-6h for 5 d or

Vancomycin 15 mg/kg IV q12h for 5 d or

Linezolid 600 mg IV q12h or

Daptomycin 4-6 mg/kg IV q24h

Special considerations

Probiotics have not been shown to improve outcomes in conjunction with antibiotics. [11]

Paracentesis should be performed in any patient suspected of SBP; to increase the sensitivity, culture bottles should be inoculated at the bedside rather than in the laboratory.

Repeat paracentesis is required only if the patient is not improving.

Albumin 1.5 g/kg IV within 6 hours of diagnosis followed by 1 g/kg IV on day 3 has been reported to decrease mortality [12] from 29% to 10% when used with appropriate antibiotics versus antibiotics and no albumin. [3]

Patients on a prophylactic fluoroquinolone who develop SBP should be placed on alternative agents. [1]

Prophylaxis is indicated after the initial episode of SBP or in patients with cirrhosis and active upper gastrointestinal bleeding. [1, 4, 13] Routine prophylaxis for patients with ascites without gastrointestinal bleeding may also be beneficial, [5] especially if the patient has high-risk features, which include ascitic fluid protein less than 1.5 g/dL and at least 1 of the following: serum creatinine greater than or equal to 1.2 mg/dL, blood urea nitrogen greater than 25 mg/dL, serum sodium less than or equal to 130 mEq/L, or Child-Pugh score greater than or equal to 9 with bilirubin greater than or equal to 3 mg/dL. [1]