A 48-year-old woman with decompensated cirrhosis (Child-Pugh C, MELD 22) is admitted with fever, abdominal pain, and confusion. Paracentesis shows ascitic fluid WBC 650 cells/µL with 80% PMN. Ascitic fluid culture grows Escherichia coli. Which statement about management is CORRECT?

• A IV albumin infusion (1.5 g/kg on day 1 and 1 g/kg on day 3) reduces risk of hepatorenal syndrome ✓
• B Oral fluoroquinolone monotherapy is adequate for uncomplicated SBP
• C Repeat paracentesis to confirm resolution is not necessary
• D Secondary prophylaxis with rifaximin is the standard of care after SBP

Explanation

IV albumin (1.5 g/kg at diagnosis, 1 g/kg on day 3) is a Class I recommendation in SBP management as it significantly reduces the incidence of type 1 hepatorenal syndrome and in-hospital mortality (SORT trial). IV cefotaxime or ceftriaxone is preferred for SBP over oral fluoroquinolones due to increasing quinolone resistance in nosocomial SBP. Repeat paracentesis at 48 hours is recommended to confirm response. Long-term prophylaxis after SBP is oral norfloxacin or ciprofloxacin (or trimethoprim-sulfamethoxazole) — rifaximin is used for hepatic encephalopathy secondary prophylaxis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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