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Spontaneous Bacterial Peritonitis — RACP Adult Medicine MCQ

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ModerateGastroenterologySpontaneous Bacterial PeritonitisRACP Adult Medicine

A 55-year-old woman with cirrhotic ascites presents with fever (38.5°C) and abdominal pain. Diagnostic paracentesis shows ascitic fluid WCC 650 cells/μL with 80% neutrophils (PMN count 520). Gram stain is negative. What is the most appropriate management?

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Correct answer: C — IV antibiotics (ceftriaxone)

Ascitic PMN count ≥250/μL defines SBP regardless of culture result. Empirical IV ceftriaxone (or cefotaxime) should be commenced immediately. IV albumin (1.5 g/kg day 1, 1 g/kg day 3) reduces renal impairment and mortality. After resolution, secondary prophylaxis with norfloxacin is recommended.

Reference: GESA – 2024 – SBP Management; EASL 2024 Decompensated Cirrhosis