A 50-year-old man with alcoholic cirrhosis is hospitalized with acute decompensation (ascites, encephalopathy). Diagnostic paracentesis: SAAG 1.5 g/dL, PMN count 380 cells/μL. He has no fever or abdominal pain. The appropriate treatment is:
- A Broad-spectrum antibiotics only if culture grows organisms
- B Oral ciprofloxacin 500 mg bd for 7 days
- C Cefotaxime 2 g IV q8h for 5 days plus IV albumin at day 1 and day 3 ✓
- D Meropenem plus fluconazole empirically
Explanation
PMN count ≥250 cells/μL in ascitic fluid confirms spontaneous bacterial peritonitis (SBP) and warrants empirical antibiotic treatment before culture results. Cefotaxime 2 g IV every 8 hours for 5 days is the standard of care. The SORT (Sort study) demonstrated that IV albumin (1.5 g/kg at diagnosis, 1 g/kg on day 3) alongside antibiotics reduces incidence of type 1 hepatorenal syndrome and in-hospital mortality significantly compared to antibiotics alone. Oral ciprofloxacin is used for SBP prophylaxis in outpatients but is not the treatment of choice for acute SBP. Empirical treatment should not await culture results.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.