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Spontaneous Bacterial Peritonitis — SCE Infectious Diseases MCQ

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ModerateRespiratory InfectionSpontaneous Bacterial PeritonitisSCE Infectious Diseases

A 50-year-old man with alcoholic cirrhosis (Child-Pugh C) is admitted with fever, abdominal pain, and tense ascites. Diagnostic paracentesis shows: WCC 850 cells/µL (90% neutrophils), protein 8 g/L, negative Gram stain. Blood cultures are pending. What is the most appropriate empirical antibiotic?

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Correct answer: B — IV Ceftriaxone 2 g once daily

Spontaneous bacterial peritonitis (SBP) is diagnosed by ascitic fluid neutrophil count ≥250 cells/µL. IV Ceftriaxone (or Cefotaxime) is the empirical antibiotic of choice for community-acquired SBP. It covers the most common causative organisms: E. coli, Klebsiella, and Streptococcus pneumoniae. IV albumin (1.5 g/kg on day 1, 1 g/kg on day 3) should also be administered to reduce renal impairment and mortality. Piperacillin/Tazobactam or Meropenem may be considered if healthcare-associated or resistant organisms are suspected.

Reference: EASL 2024 – Guidelines on decompensated cirrhosis; BSG 2023 – Management of ascites and SBP