SBP Prophylaxis — RACP Adult Medicine MCQ
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Correct answer: B — Prevents hepatorenal syndrome only
Secondary SBP prophylaxis with daily norfloxacin (400 mg once daily) reduces 1-year SBP recurrence from approximately 70% to 20%. Primary SBP prophylaxis is indicated in patients with ascitic fluid protein <15 g/L plus either renal impairment or liver failure (Child-Pugh ≥9 with bilirubin ≥50 µmol/L). The benefit extends to reduced short-term mortality. Trimethoprim-sulfamethoxazole is an alternative if norfloxacin is unavailable.
Reference: eTG – 2025 – Antibiotic Guidelines; Baveno VII – 2022 – Portal Hypertension Consensus