Primary prophylaxis of spontaneous bacterial peritonitis in patients with cirrhosis

Primary antibiotic prophylaxis is only recommended for patients with cirrhosis who are at high risk of spontaneous bacterial peritonitis. Prophylaxis reduces the risk of spontaneous bacterial peritonitis and all-cause mortality in these patients.

To be considered at high risk, patients must have cirrhosis, ascites, an ascitic fluid protein concentration less than 15 g/L, and at least one ofBiggins, 2021Liver, 2010National Institute for Clinical Excellence (NICE). 2023:

• impaired kidney function (serum creatinine 110 micromol/L or more, serum urea nitrogen 8.9 mmol/L or more, or serum sodium 130 mmol/L or less)
• liver failure (Child–Pugh score 9 or more or a Model for End-stage Liver Disease [MELD] score of more than 16, and serum bilirubin 50 micromol/L or more)National Institute for Clinical Excellence (NICE). 2023.

For primary antibiotic prophylaxis, use the same regimen as for secondary prophylaxis.