SBP — RACP Adult Medicine MCQ

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EasyGastroenterology & HepatologySBPRACP Adult Medicine

A 55-year-old man with alcohol-related cirrhosis is admitted with tense ascites. Diagnostic paracentesis shows PMN count 350 cells/mm³ and total protein 8 g/L. What is the first-line antibiotic for spontaneous bacterial peritonitis?

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Correct answer: C — IV ceftriaxone 1 g daily

Ascitic fluid PMN count ≥250 cells/mm³ defines SBP. First-line empirical antibiotic is IV third-generation cephalosporin (ceftriaxone 1–2 g daily or cefotaxime 2 g 8-hourly) for 5 days. IV albumin (1.5 g/kg day 1, 1 g/kg day 3) should be co-administered to reduce the incidence of hepatorenal syndrome and mortality. Repeat paracentesis at 48 hours should show >25% decline in PMN count to confirm response.

Reference: eTG – 2025 – Antibiotic Guidelines; EASL – 2018 – Decompensated Cirrhosis Guidelines