A 48-year-old man with cirrhosis and tense ascites undergoes diagnostic paracentesis. Ascitic fluid protein is 1.0 g/dL. He has no prior history of spontaneous bacterial peritonitis. Child-Pugh score is 10, serum creatinine 1.5 mg/dL, sodium 128 mEq/L. Which of the following is indicated for primary prophylaxis of SBP?

• A Oral ciprofloxacin 750 mg weekly
• B No prophylaxis needed at this time
• C Intravenous ceftriaxone weekly
• D Oral norfloxacin 400 mg daily ✓

Explanation

Primary prophylaxis is indicated in patients with ascitic fluid protein <1.5 g/dL and either Child-Pugh ≥9, serum creatinine ≥1.2 mg/dL, or serum sodium ≤130 mEq/L. This patient meets all three criteria. Norfloxacin 400 mg daily or ciprofloxacin 750 mg weekly reduces SBP risk. IV antibiotics are not used for primary prophylaxis. Without prophylaxis, his risk of SBP is high.

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

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