Spontaneous bacterial peritonitis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2] Ahmed Younes M.B.B.CH [3]


Early diagnosis and initiating treatment is the most important factor for improving the survival and avoiding the complications of SBP. The sooner the diagnosis, the better the outcome.

Natural history

  • SBP is treatable with antibiotics but early diagnosis and intiation of empiric antibiotic therapy is the most important factor for survival.
  • In a study performed in 2006, Each hour of delay of administration of empiric antibiotics was associated with increased mortality by 7.6% while administration of antibiotics at the first hour of hypotension increased overall survival to 79%.[1]


The physician should have a high index of suspicion to diagnose SBP early and start empiric antibiotic therapy. The earlier the stage of diagnosis, the better the survival.

Hypotension, hypothermia and shock:

Altered mental status:

Paralytic ileus:




  1. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M (2006). "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock". Crit. Care Med. 34 (6): 1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PMID 16625125.
  2. Guarner C, Runyon BA, Young S, Heck M, Sheikh MY (1997). "Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites". J. Hepatol. 26 (6): 1372–8. PMID 9210626.
  3. Sundaram V, Manne V, Al-Osaimi AM (2014). "Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers". Saudi J Gastroenterol. 20 (5): 279–87. doi:10.4103/1319-3767.141686. PMC 4196342. PMID 25253362.
  4. "Spontaneous bacterial peritonis - ScienceDirect".