A 55-year-old man with decompensated alcoholic cirrhosis (Child-Pugh C) develops spontaneous bacterial peritonitis (SBP). Paracentesis shows PMN count of 380/mm³. He is started on cefotaxime. Which additional intervention reduces 3-month mortality in this setting?
- A Add rifaximin to prevent hepatic encephalopathy
- B Administer IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- C Start prophylactic norfloxacin for secondary prevention immediately
- D Perform therapeutic large-volume paracentesis immediately
Correct answer: B. Administer IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
Explanation
In SBP, intravenous albumin infusion (1.5 g/kg on day 1 and 1 g/kg on day 3) significantly reduces the incidence of hepatorenal syndrome and decreases 3-month mortality (Sort et al. trial, NEJM 1999). This is one of the strongest evidence-based interventions in hepatology. The mechanism involves volume expansion, prevention of circulatory dysfunction, and anti-inflammatory properties of albumin. Norfloxacin secondary prophylaxis is important for future prevention but does not affect acute mortality.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.