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Evaluation and initial management for adult patients with suspected spontaneous bacterial peritonitis

Evaluation and initial management for adult patients with suspected spontaneous bacterial peritonitis
Refer to content on management of spontaneous bacterial peritonitis.
PMN: polymorphonuclear leukocyte; IV: intravenous; PaO2: partial pressure of arterial oxygen; FiO2: fraction of inspired oxygen.
* The chronic liver failure-sequential organ failure assessment (CLIF-SOFA)[1] score includes subscores ranging from 0 to 4 for each of six components (bilirubin, serum creatinine, hepatic encephalopathy grade, international normalized ratio, amount of vasoactive medication necessary to prevent hypotension, and pulmonary status [PaO2/FiO2]). Higher scores indicate more severe organ impairment.
¶ Dosing is for adult patients with normal kidney function; refer to individual drug information monographs for more detail, including dosage adjustments (eg, for organ impairment). For patients with an allergy to cephalosporins, a fluoroquinolone such as ciprofloxacin is an alternative option, provided that a fluoroquinolone had not been given as prophylaxis.
Δ For treatment of spontaneous bacterial peritonitis, carbapenems are reserved for patients with severe disease (eg, those who are critically ill). Choice of carbapenem is based on local resistance panels, drug availability, and local formulary options. Examples of carbapenems include ertapenem, imipenem, and meropenem.
Albumin 25% solution is administered at diagnosis (1.5 g/kg IV; maximum dose: 100 g) and on day 3 (1 g/kg IV; maximum dose: 100 g) if creatinine is >1 mg/dL (88 micromol/L), the blood urea nitrogen is >30 mg/dL (10.7 mmol/L), or the total bilirubin is >4 mg/dL (68 micromol/L).
Reference:
  1. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144:1426.
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