[Therapy of spontaneous bacterial peritonitis]

The outcome of untreated spontaneous bacterial peritonitis (SBP) is fatal. In the onset of SBP clinical manifestations may be subtle, therefore every patient with hepatogenic ascites has to be examined for SBP at admission. If polynuclear cell count in ascitic fluid exceeds 250/microliter, antibiotic therapy has to begin immediately, until irreversible complications develop. Aerobic gram-negative bacilli of the normal intestinal flora are responsible for most cases of SBP, followed by gram-positive organisms and anaerobes. Antibiotic agents with extended spectrum, such as third-generation cephalosporins are considered the drugs of choice for SBP. In severe cases combination with metronidazole is recommended. As soon as repeated paracenteses show polynuclear cells beyond 250/microliter, the antibiotic therapy can be stopped. Selective decontamination of the gut with norfloxacin is effective to prevent SBP in high-risk patients. Trimethoprim-sulfamethoxazole is superior due to its activity even against gram-positive organisms. Overall prognosis of patients with SBP, however, is determined mainly to complications specific for cirrhosis, e.g. variceal bleeding, coma etc.