Spontaneous Bacterial Peritonitis (SBP) Diagnosis
Diagnostic criteria for spontaneous bacterial peritonitis (SBP) in cirrhotic ascites. PMN count from diagnostic paracentesis is the gold standard.
Score interpretation
PMN <250 and culture negative. SBP not confirmed.
→ Continue standard cirrhosis management. If symptoms present, repeat paracentesis or treat empirically if high clinical suspicion.
PMN ≥250 but culture negative — treat as SBP (CNNA has same prognosis). OR culture positive without raised PMN.
→ Empirical antibiotics (IV cefotaxime 2g TDS or co-amoxiclav). Albumin infusion (1.5 g/kg on Day 1, 1 g/kg on Day 3) to prevent HRS. Repeat paracentesis at 48 hours.
PMN ≥250 with positive culture — confirmed SBP.
→ IV antibiotics (cefotaxime or piperacillin-tazobactam if nosocomial). IV albumin (1.5 g/kg Day 1 + 1 g/kg Day 3). Monitor for HRS. Antibiotic prophylaxis (norfloxacin/rifaximin) after resolution. Assess transplant candidacy.
Interpretation bands for the SBP Criteria. Apply clinical judgement and local guidance.
References
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460.
- Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653.
Related
Curated clinical cross-links plus same-class fallbacks.
- AIR Score for Appendicitis · Diagnostic
- Modified Alvarado Score (MANTRELS) for Appendicitis · Diagnostic
- New Orleans Head CT Decision Rule · Diagnostic
- MS Phenotype Classification (McDonald / Phenotype) · Diagnostic
- CHALICE Rule for Childhood Head Injury · Diagnostic
- STONE Score for Uncomplicated Ureteral Stones · Diagnostic
- Spironolactone (Ascites / Cirrhosis) · Aldosterone Antagonist / Potassium-Sparing Diuretic
- Furosemide (Ascites / Cirrhosis) · Loop Diuretic
- Anthrax Vaccine · Vaccine (Bacterial — Anthrax Prevention)
- Metronidazole (Bacterial Vaginosis) · Antibiotic (Nitroimidazole) — BV Treatment
- Fluorescein Sodium 2% Eye Drops · Diagnostic ophthalmic dye
- Indocyanine Green (Intravitreal Chromovitrectomy) · Diagnostic Dye — Vitreoretinal Surgery / ICG Angiography
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.