Secondary prophylaxis of spontaneous bacterial peritonitis in patients with cirrhosis
For secondary prophylaxis of spontaneous bacterial peritonitis in adults and children with ascites due to cirrhosis, use:
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, daily. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment . trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
Although more published trials have used norfloxacin for the secondary prophylaxis of spontaneous bacterial peritonitis, trimethoprim+sulfamethoxazole is preferred to minimise emergence of resistance to quinolones (both in the individual and the wider community)Alvarez, 2005Lontos, 2014Singh, 1995. However, norfloxacin is preferred for secondary prophylaxis of spontaneous bacterial peritonitis in patients:
- who have an episode of spontaneous bacterial peritonitis while taking trimethoprim+sulfamethoxazole for secondary prophylaxis
- with hypersensitivity to trimethoprim+sulfamethoxazole (assess patients reporting hypersensitivity to trimethoprim+sulfamethoxazole – for adults, see here or for children, seek expert advice)
- in whom a trimethoprim+sulfamethoxazole-resistant organism is cultured from a previous episode of spontaneous bacterial peritonitis.
If norfloxacin is preferred for secondary prophylaxis of spontaneous bacterial peritonitis, use:
norfloxacin 400 mg (child: 10 mg/kg up to 400 mg) orally, daily12. For dosage adjustment in adults with kidney impairment, see norfloxacin dosage adjustment. norfloxacin norfloxacin norfloxacin
Multiple studies have examined other antibiotic prophylaxis options (eg rifaximin, ciprofloxacin); however, there is not enough high-quality evidence to recommend their useKomolafe, 2020.