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SBP in Beta-Lactam Allergy — SCE Infectious Diseases MCQ

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ModerateHepatitisSBP in Beta-Lactam AllergySCE Infectious Diseases

A 60-year-old man with cirrhosis and portal hypertension presents with fever, confusion, and tense ascites. Ascitic fluid neutrophil count is 380 cells/µL. He is allergic to penicillin (anaphylaxis) and cephalosporins (urticaria). What empirical antibiotic is most appropriate for SBP?

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Correct answer: C — IV Ciprofloxacin 400 mg BD

With both penicillin (anaphylaxis) and cephalosporin allergy, beta-lactam agents are contraindicated. IV Ciprofloxacin is the recommended alternative for SBP in penicillin/cephalosporin-allergic patients, providing coverage against the common SBP pathogens (E. coli, Klebsiella, S. pneumoniae). Meropenem could be considered (very low cross-reactivity with penicillins in anaphylaxis) but is unnecessarily broad. IV albumin should also be administered (1.5 g/kg on day 1, 1 g/kg on day 3).

Reference: EASL 2024 – Decompensated cirrhosis; BSG 2021 – SBP management