A 55-year-old man with alcoholic cirrhosis (Child-Pugh C, MELD-Na 22) presents with his second episode of spontaneous bacterial peritonitis. Ascitic fluid shows PMN count 320 cells/µL. He is started on cefotaxime. Which additional intervention has been shown in a randomised trial to reduce mortality in SBP?
- A Oral norfloxacin for long-term secondary prophylaxis
- B IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- C Terlipressin infusion to prevent hepatorenal syndrome
- D Therapeutic paracentesis to remove infected ascitic fluid
Correct answer: B. IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
Explanation
The landmark Sort et al. (NEJM 1999) trial demonstrated that IV albumin (1.5 g/kg at diagnosis, 1 g/kg on day 3) reduces the incidence of hepatorenal syndrome type 1 and significantly improves in-hospital survival in SBP. Albumin prevents renal impairment by counteracting circulatory dysfunction triggered by bacterial translocation and cytokines. Norfloxacin is used for secondary SBP prophylaxis but does not alter acute mortality. Terlipressin treats established HRS but is not given prophylactically in SBP without HRS.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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