What are the guidelines for prophylaxis against SBP in patients with advanced liver disease?

Antibiotics are not routinely offered to prevent spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites ¹.

However, antibiotics may be considered for SBP prophylaxis in specific circumstances:

• If the person is at high risk of developing SBP due to severe liver disease ¹,². This includes individuals with an ascitic protein of 15 g per litre or less, a Child–Pugh score of more than 9, or a MELD score of more than 16 ¹.
• If the consequences of an infection could seriously impact the person's care, such as affecting their wait for a transplant or a transjugular intrahepatic portosystemic stent insertion (TIPS) ¹,².

When offering antibiotics for SBP prevention, it is important to follow local microbiological advice and continue treatment until the ascites has resolved ¹.

Separately, prophylactic intravenous antibiotics should be offered to people with cirrhosis who have upper gastrointestinal bleeding ¹.