Modification and duration of therapy for spontaneous bacterial peritonitis

For patients with spontaneous bacterial peritonitis, modify antibiotic therapy according to the results of culture and susceptibility testing. If signs and symptoms of infection improve rapidly, treat for 5 days.

If signs and symptoms of infection are slow to respond to therapy and initial cultures remain negative, repeat the ascitic tap for cell count and culture and susceptibility testing (see Aetiology and assessment of spontaneous bacterial peritonitis)Biggins, 2021Liver, 2010. If neutrophil count has not decreased by more than 25% from baseline, consider broadening antimicrobial spectrum and investigating for secondary peritonitisBiggins, 2021Liver, 2010 – seek expert adviceBiggins, 2021Liver, 2010.