A 52-year-old man with alcoholic cirrhosis (Child-Pugh C, MELD 22) presents with fever, abdominal pain, and confusion. Paracentesis shows 350 PMN/µL in ascitic fluid. Blood cultures are pending. The most appropriate immediate management is:
- A IV cefotaxime 2g every 8 hours plus IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- B Oral ciprofloxacin and await culture results
- C IV cefotaxime alone without albumin
- D Rifaximin plus lactulose for hepatic encephalopathy only
Correct answer: A. IV cefotaxime 2g every 8 hours plus IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
Explanation
Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic fluid PMN count ≥250 cells/µL. Immediate empirical treatment with IV cefotaxime (3rd-generation cephalosporin) is standard. Concomitant IV albumin (1.5 g/kg day 1, 1 g/kg day 3) is evidence-based (Sort et al. NEJM 1999 landmark trial) and significantly reduces hepatorenal syndrome development and in-hospital mortality. Albumin supplementation is mandatory given the high MELD score indicating high risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.