Spontaneous bacterial peritonitis secondary prevention

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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]


Following a first episode of spontaneous bacterial peritonitis, the recurrence rate at one year is ~70%, with a 1-year overall survival rate of 30-50% in patients who do not receive antibiotic prophylaxis. Cirrhotic patients with ascites and a prior history of SBP, receiving antibiotic prophylaxis there is a reduction in the risk of recurrence from 68% to 20%. Accordingly, daily long-term antimicrobial prophylaxis are recommended for patients with a history of one or more episodes of SBP.[1]

Secondary Prevention

Secondary SBP prophylaxis
Indications Preferred therapy Alternative therapy Duration of treatment Prognosis Complications
  • Previous history of SBP
  • Indefinite, unless ascites resolves.
  • Reduction in the recurrence rate of SBP from 68% to 20%.

Several studies have shown that oral norfloxacin 400 mg daily prevents spontaneous bacterial peritonitis in patients with low-protein ascites and those with previous history of spontaneous bacterial peritonitis (SBP). Norfloxacin reduced SBP recurrence rates from 68% to 20%.


  1. Alaniz C, Regal RE (2009). "Spontaneous bacterial peritonitis: a review of treatment options". P T. 34 (4): 204–10. PMC 2697093. PMID 19561863.
  2. Novella, M; Sola, R; Soriano, G; Andreu, M; Gana, J; Ortiz, J; Coll, S; Sabat, M; Vila, M C; Guarner, C; Vilardell, F (1997). "Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin". Hepatology. 25 (3): 532–536. doi:10.1002/hep.510250306. ISSN 0270-9139.
  3. http://guideline.gov/content.aspx?id=14887&search=ascitis
  4. Ginés, Pere; Rimola, Antoni; Planas, Ramón; Vargas, Victor; Marco, Francesc; Almela, Manuel; Forne, Montserrat; Miranda, Maria Luisa; Llach, Josep; Salmerón, Joan Manuel; Esteve, Maria; Marques, Josep Maria; de Anta, Maria Teresa Jiménez; Arroyo, Vicente; Rodés, Joan (1990). "Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Results of a double-blind, placebo-controlled trial". Hepatology. 12 (4): 716–724. doi:10.1002/hep.1840120416. ISSN 0270-9139.
  5. Runyon BA (1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology. 91 (6): 1343–6. PMID 3770358.
  6. Grangé JD, Roulot D, Pelletier G; et al. (1998). "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial". J. Hepatol. 29 (3): 430–6. PMID 9764990.
  7. Elfert, Asem; Abo Ali, Lobna; Soliman, Samah; Ibrahim, Shimaa; Abd-Elsalam, Sherief (2016). "Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis". European Journal of Gastroenterology & Hepatology. 28 (12): 1450–1454. doi:10.1097/MEG.0000000000000724. ISSN 0954-691X.
  8. Dong, Tien; Aronsohn, Andrew; Gautham Reddy, K.; Te, Helen S. (2016). "Rifaximin Decreases the Incidence and Severity of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis". Digestive Diseases and Sciences. 61 (12): 3621–3626. doi:10.1007/s10620-016-4313-0. ISSN 0163-2116.