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Gram-Negative SBP — RACP Paediatrics MCQ

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ModerateInfectious DiseaseGram-Negative SBPRACP Paediatrics

A 9-year-old child with nephrotic syndrome on immunosuppression develops fever, abdominal pain, and peritonitis. Ascitic fluid culture grows E. coli. What antibiotic adjustment is needed compared to pneumococcal SBP?

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Correct answer: B — Broader Gram-negative coverage is confirmed; continue ceftriaxone/cefotaxime

While S. pneumoniae is the most common cause of SBP in nephrotic syndrome, E. coli and other Gram-negative organisms also cause SBP. Third-generation cephalosporins (ceftriaxone/cefotaxime) provide adequate coverage for both. Culture and sensitivity results should guide definitive therapy.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Nephrotic Syndrome Complications