A 50-year-old man with hepatitis C-related cirrhosis (Child-Pugh B) develops fever, abdominal pain, and confusion. Ascitic fluid shows 480 PMN/µL. He is started on cefotaxime. What must be co-administered to prevent hepatorenal syndrome?
- A Oral norfloxacin prophylaxis
- B Intravenous albumin (1.5 g/kg on day 1, 1 g/kg on day 3) ✓
- C Terlipressin alone
- D N-acetylcysteine infusion
Explanation
The SORT-V (Société Française de) randomized trial and subsequent meta-analyses established that intravenous albumin given alongside antibiotics in spontaneous bacterial peritonitis (SBP) significantly reduces both hepatorenal syndrome (HRS) development and in-hospital mortality. The regimen is 1.5 g/kg IV albumin on day 1 and 1 g/kg on day 3. Albumin maintains effective circulating volume and suppresses systemic inflammatory response. This is a Class IA recommendation in EASL cirrhosis guidelines. Norfloxacin is long-term secondary prophylaxis after SBP resolution, not acute co-treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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