Abstract
Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease. SBP can present with many symptoms such as abdominal pain, fever and altered mental status.1 The diagnosis of SBP is made when ascitic fluid from a paracentesis has an absolute neutrophil count (ANC) more than 250/uL, there is a positive ascitic fluid culture, and no secondary source of infection can be idenitifed.2 However, nearly 60% of patients with SBP have negative fluid cultures.3 These patients can still potentially have SBP and should be treated as such since in-hospital mortality ranges from 20-40%.1,4 Conventional treatment for SBP includes a third-generation cephalosporin for five days, followed by lifetime prophylaxis most commonly with a fluoroquinolone. 5 After 48 hours of antibiotic treatment, a repeat paracentesis should be performed. If the ANC does not decrease by at least 25%, it is considered a therapeutic failure and the antibiotic should be changed.5 With early diagnosis and appropriate antibiotic regimen, SBP is treatable.
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