A 58-year-old man with alcoholic cirrhosis develops spontaneous bacterial peritonitis (SBP). Ascitic fluid PMN count is 280 cells/µL. Blood cultures are negative. The preferred antibiotic and the key adjunctive therapy to prevent hepatorenal syndrome in this patient are:
- A Cefotaxime 2 g IV 8-hourly plus IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 ✓
- B Oral ciprofloxacin alone
- C Cefotaxime without albumin
- D Metronidazole plus gentamicin
Explanation
EASL and AASLD guidelines recommend intravenous cefotaxime (or equivalent third-generation cephalosporin) as first-line for SBP. Critically, the Sort et al. landmark trial demonstrated that IV albumin (1.5 g/kg on day 1, 1 g/kg on day 3) significantly reduces the incidence of renal impairment and in-hospital mortality in SBP patients with creatinine >1 mg/dL, bilirubin >4 mg/dL, or BUN >30 mg/dL. Albumin is now standard adjunctive therapy for patients with these risk factors. Oral ciprofloxacin is used for SBP prophylaxis but is not the treatment of choice. Metronidazole and aminoglycosides are not appropriate for SBP.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.