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DRUG INFORMATION ROUNDS

Long-Term Prophylaxis of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Pharmacotherapy Specialist, Internal Medicine, Akron General Medical Center, Akron, OH; Associate Professor of Clinical Pharmacology in Internal Medicine, Northeastern Ohio Universities College of Medicine, Akron

Antonio E Marinos, MD

Internal Medicine Resident, Akron General Medical Center

Amy M Rybarczyk, PharmD

Pharmacotherapy Specialist, Internal Medicine, Akron General Medical Center

Scott A Fulton, MD

Gastroenterologist, The Gastroenterology Group, Inc., Akron; Assistant Professor of Medicine, Northeastern Ohio Universities College of Medicine

Reprints: Dr. Frazee, Akron General Medical Center, 400 Wabash Ave., Akron, OH 44307-2463, fax 330/996-2395, lfrazee{at}agmc.org

OBJECTIVE: To review the literature regarding long-term prophylaxis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis.

DATA SOURCES: A MEDLINE (1967–September 2004) and bibliographic search of the English-language literature was conducted using the search terms spontaneous bacterial peritonitis, cirrhosis, antimicrobial, and prophylaxis.

DATA SYNTHESIS: Long-term antimicrobial prophylaxis has been shown to decrease recurrent SBP in cirrhotics with a prior episode. Prophylaxis in patients with low ascitic fluid protein has also been shown to reduce the incidence of SBP; however, studies are too in-homogeneous to identify subgroups that benefit the most.

CONCLUSIONS: Long-term antimicrobial therapy should be considered for secondary prophylaxis of SBP. Studies should be done to confirm this benefit and identify subsets of patients with low ascitic fluid protein who clearly benefit.

Key Words: antimicrobial, ascites, cirrhosis, peritonitis

Published Online, March 15, 2005. www.theannals.com, DOI 10.1345/aph.1E585