Spontaneous Bacterial Peritonitis — SCE Infectious Diseases MCQ

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ModerateHepatitisSpontaneous Bacterial PeritonitisSCE Infectious Diseases

A 55-year-old man with alcoholic liver disease develops spontaneous bacterial peritonitis. He recovers with IV Ceftriaxone. What secondary prophylaxis should be prescribed to prevent SBP recurrence?

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Correct answer: E — Ciprofloxacin 500 mg daily (or Norfloxacin 400 mg daily)

After a first episode of SBP, the recurrence rate is approximately 70% within one year without prophylaxis. Long-term secondary prophylaxis with a fluoroquinolone (Norfloxacin 400 mg daily or Ciprofloxacin 500 mg daily) significantly reduces recurrence. Co-trimoxazole is an alternative. Prophylaxis should continue until transplant, death, or resolution of ascites. Primary SBP prophylaxis is also indicated for patients with ascitic protein <15 g/L plus additional risk factors.

Reference: EASL 2024 – Decompensated cirrhosis guidelines; BSG 2021 – Ascites management