Treatment of spontaneous bacterial peritonitis

Abstract

Spontaneous bacterial peritonitis is a common infection in cirrhotics with a mortality rate of up to 20%. The chain of events that eventually lead to spontaneous bacterial peritonitis begins with liver cirrhosis and chronic liver failure, continues with bacterial overgrowth and translocation followed by infection of the lymph nodes and ascites. Most common etiologically are large intestine bacteria such as E. coli and enterococci, but also streptococcus sp. Despite the relative thorough description of ethiopathogenesis, the specific guidelines for management of this complication were introduced by the European Association for Study of the Liver as late as in 2010. One of the major reasons was the lack of evidence from clinical studies about the treatment of spontaneous bacterial peritonitis. In this article, the reader will find a review of published papers and EASL guidelines about spontaneous bacterial peritonitis treatment, primary and secondary prophylaxis.