Spontaneous Bacterial Peritonitis.

A suspicion, even if low, of spontaneous bacterial peritonitis (SBP) should prompt a diagnostic paracentesis to be performed on presentation. Empiric antibiotic therapy with a third-generation cephalosporin should commence upon demonstration of over 250 granulocytes/mm(3) in ascitic fluid. Treatment for 5 days in uncomplicated SBP is sufficient; persistent symptoms and/or ascites fluid showing persistent granulocytosis (over 250 cells/mm(3)) should be handled by broadening of antibiotic spectrum and searching for secondary causes of peritonitis. Antibiotic prophylaxis for cirrhotic patients with ascites and acute gastrointestinal hemorrhage and in those with a prior history of SBP is indicated.