What is the treatment for spontaneous bacterial peritonitis (SBP)?

Spontaneous bacterial peritonitis (SBP) is a common and serious infection that occurs in patients with cirrhosis and ascites, typically resulting from the translocation of bacteria from the gut into the peritoneal cavity. The treatment of choice for SBP is cefotaxime, a third-generation cephalosporin antibiotic that effectively targets the gram-negative bacteria commonly involved in this condition, such as Escherichia coli and Klebsiella pneumoniae.

Cefotaxime is preferred due to its broad-spectrum activity against these pathogens, its favorable pharmacokinetic profile, and its ability to penetrate well into the peritoneal cavity, which enables effective treatment of the infection. Appropriate antibiotic therapy should be started promptly upon diagnosis to prevent further complications, including progression to sepsis and kidney impairment.

The other options do not align as well with the standard treatment guidelines for SBP. Cefazolin, primarily effective against skin flora and some gram-positive organisms, is not the ideal choice. Amoxicillin, while useful for certain infections, lacks the spectrum needed to adequately cover the gram-negative bacteria typically responsible for SBP. Vancomycin, which targets gram-positive organisms, is not consistently effective against the common pathogens