Secondary SBP Prophylaxis — SCE Infectious Diseases MCQ
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Correct answer: B — Oral Norfloxacin 400 mg daily (or Ciprofloxacin 500 mg daily) as secondary SBP prophylaxis — lifelong or until liver transplant
After recovery from a first episode of spontaneous bacterial peritonitis (SBP), patients with cirrhosis should receive secondary antibiotic prophylaxis because recurrence risk is high. UK hepatology guidance recommends continuous oral fluoroquinolone prophylaxis: norfloxacin 400 mg once daily; because norfloxacin has limited UK availability, many UK centres use ciprofloxacin 500 mg once daily as an alternative. This is started after the acute SBP episode has resolved and is continued long term, typically lifelong or until successful liver transplantation/resolution of the risk state. Co-amoxiclav and oral vancomycin are not standard secondary SBP prophylaxis, and prophylaxis should not be delayed until a second episode.
Reference: British Society of Gastroenterology/BASL. Guidelines on the management of ascites in cirrhosis. Gut 2021;70:9-29. https://gut.bmj.com/content/70/1/9