Spontaneous Bacterial Peritonitis and Spontaneous Bacterial Pleuritis

Top tips:

  1. Speed is life in cirrhosis when infection is suspected. Early and Appropriate antibiotics reduce mortality.
  2. Paracentesis and Thoracentesis before antibiotics is ideal. But, if you have a high suspicion of infection and these cannot be arranged in a timely manner, do not delay antibiotics.
  3. You must consider risk factors for multi-drug resistance (i.e. recent hospitalizations, colonization with multi-drug resistant organisms, nursing home resident) when choosing your antibiotics.
  4. De-escalate/narrow antibiotics as soon as a pathogen is identified on culture.
  5. All patients should be started on secondary prophylaxis with antibiotics once a diagnosis of SBPeritonitis or SBPleuritis is made. Contrary to earlier evidence, patients with low albumin ascites do not require primary prophylaxis.

Order panel for SB Peritonitis or SB Pleuritis:

For adults with cirrhosis admitted with Spontaneous Bacterial Peritonitis (ascites PMN >250 cells/µL) or Spontaneous Bacterial Pleuritis (pleural fluid PMN >500 cells/µL or >250 cells/µL with positive culture):
 SB-Peritonitis-Pleuritis Order Panel

Check out the bottom of the page for short videos from Dr. Saxinger!

Diagnosis

Specific Management

Introducing Dr. Saxinger

Video 1 – Practical tips for diagnosing Spontaneous bacterial peritonitis and Spontaneous bacterial pleuritis in cirrhosis.

Coming soon!

Video 2 - How do I decide which antibiotic should be given and for how long? What about secondary prophylaxis?

Coming soon!

Patient materials:

You can direct patients to the following:
Paracentesis

Lab tests

 

Downloadable content:

You can download these to print or view offline:
EASL Guidelines

References:

This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.
Authors: Dr. Lynora Saxinger, Dr. Dean Karvellas, Dr. Uma Chandran, Dr. Puneeta Tandon
References:

  1. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018 Aug;69(2):406-460 PMID 29653741
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