Spontaneous bacterial peritonitis

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In medicine, spontaneous bacterial peritonitis (SB) is a form of peritonitis that occurs in patient with ascites.[1] Monomicrobial nonneutrocytic bacterascites is a positive culture for a pure growth of a single type of organism but the neutrophil count is less than 250 cells/mm3.[2] About a third of patients with monomicrobial nonneutrocytic bacterascites will progress to SBP.[2]


Proton pump inhibitors may be associated with SBP.[3]


Physical examination

On physical examination, most patients have mild abdominal pain.[4] The impression of the physician performing the physical examination may not be accurate:[4]

Regarding individual signs and symptoms:

Ascitic fluid analysis

Performance and interpretation of the paracentesis has been systematically reviewed by the Rational Clinical Examination.[5]


The role of antibiotics is not clear.[6]

Oral treatment

"Oral quinolones could be considered an option for those with less severe manifestations" according to the Cochrane Collaboration.[6]

Randomized controlled trials of oral antibiotics for spontaneous bacterial peritonitis[7][8][9][10][11]
Trial Patients Comparison Outcome Results
Intervention Control
53 patients Oral ciprofloxacin versus one of two IV third-generation cephalosporins SBP resolution 84% 76% and 83%
48 patients Oral amoxicillin-clavulanic acid for an average of 2.6 days then orallly for an average of 5.6 days versus cefotaxime IV for an average of 8 days Hospital survival 90% 83%
80 patients. No exclusion criteria Oral ciprofloxacin for five days after IV for two days versus ciprofloxacin IV for seven days Hospital survival 77.5% 77.5%
38 patients Oral cefixime versus IV ceftriaxone Survival after two days of stopping antibiotics 80% 83%
123 patients. Excluded septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus Oral ofloxacin versus IV cefotaxime Hospital survival 100% 100%


  1. ICD9: 567.23
  2. 2.0 2.1 Runyon BA (1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis.". Hepatology 12 (4 Pt 1): 710-5. PMID 2210672.
  3. Bajaj JS, Zadvornova Y, Heuman DM, et al. (May 2009). "Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites". Am. J. Gastroenterol. 104 (5): 1130–4. DOI:10.1038/ajg.2009.80. PMID 19337238. Research Blogging.
  4. 4.0 4.1 Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW (September 2008). "Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis". Ann Emerg Med 52 (3): 268–73. DOI:10.1016/j.annemergmed.2008.02.016. PMID 18433932. Research Blogging.
  5. Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE (2008). "Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?". JAMA 299 (10): 1166-78. DOI:10.1001/jama.299.10.1166. PMID 18334692. Research Blogging.
  6. 6.0 6.1 Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L (2009). "Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients". Cochrane Database Syst Rev (1): CD002232. DOI:10.1002/14651858.CD002232.pub2. PMID 19160207. Research Blogging.
  7. 7.0 7.1 Tuncer I, Topcu N, Durmus A, Turkdogan MK (2003 Sep-Oct). "Oral ciprofloxacin versus intravenous cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis.". Hepatogastroenterology 50 (53): 1426-30. PMID 14571754.
  8. 8.0 8.1 Ricart E, Soriano G, Novella MT, Ortiz J, Sàbat M, Kolle L et al. (2000). "Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients.". J Hepatol 32 (4): 596-602. DOI:10.1016/S0168-8278(00)80221-4. PMID 10782908. Research Blogging.
  9. 9.0 9.1 Terg R, Cobas S, Fassio E, Landeira G, Ríos B, Vasen W et al. (2000). "Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study.". J Hepatol 33 (4): 564-9. PMID 11059861.
  10. 10.0 10.1 Figueiredo FAF, Coelho HSM, Soares JAS, Salgueiro E, Pinto CA. Oral cephalosporin for the treatment of non-severe spontaneous bacterial peritonitis in liver disease: a prospective study of 38 cases [Cefalosporina oral para o tratamento da peritonite bacteriana espontanea nao complicada na cirrose hepatica: um estudo prospectivo de 38 casos]. GED - Gastrenterologia-Endoscopia-Digestiva 1997;16(6):231-6.
  11. 11.0 11.1 Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, et al.Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996;111(4):1011-7. DOI:10.1016/S0016-5085(96)70069-0