Peritonitis – Spontaneous Bacterial (Primary)

A group of diseases with different causes, having in common only an infection in the peritoneal cavity without an obvious source of peritoneal contamination. It usually occurs in patients with chronic liver disease and ascites.

  • Take blood and peritoneal fluid cultures.
  • Spontaneous bacterial peritonitis (SBP) is typically mono-microbial. Polymicrobial infections suggest bowel perforation – see secondary peritonitis.

Usual Pathogens
Enterobacteriaceae
Occassionally:
S. pneumoniae
Streptoccocus spp.

Recommended Empiric Therapy (5-7 days)

Ceftriaxone 1 g IV q24h

Oral (sequential therapy) regimens

Amoxicillin-clavulanate 500 mg PO TID
Penicillin allergic (clear history)
TMP/SMX 1 DS tab PO BID