Spontaneous Bacterial Peritonitis: An Update

Jorge A. Gilbert, Patrick S. Kamath

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


To describe spontaneous bacterial peritonitis (SBP) in the context of currently accepted criteria for diagnosis, treatment, and prevention. A review of SBP and its associated etiopathogenic factors is presented. Numerous studies on mechanisms of disease, diagnosis, treatment, and prevention are discussed. Diagnostic and therapeutic algorithms are presented. Peritonitis in patients with ascites in the absence of secondary causes, such as perforation of a viscus, occurs primarily in patients with end-stage liver disease. Enteric organisms, mainly gram-negative bacilli, probably translocate to regional lymph nodes to produce bacteremia and seeding of ascitic fluid. Signs and symptoms of peritonitis are usually subtle. The ascitic fluid polymorphonuclear leukocyte count is the best determinant for early diagnosis and treatment of SBP. Third-generation cephalosporins such as cefotaxime are considered the drugs of choice for treatment, whereas quinolones such as norfloxacin are used to decrease recurrence. Despite increased awareness, early diagnosis, and prompt and effective antimicrobial therapy, SBP recurs frequently and is associated with a high mortality rate. Patients with SBP should be assessed for candidacy for liver transplantation.

Original languageEnglish (US)
Pages (from-to)365-370
Number of pages6
JournalMayo Clinic proceedings
Issue number4
StatePublished - 1995


  • BA
  • CNNA
  • PMNs
  • SBP
  • bacterascites
  • culture-negative neutrocytic ascites
  • polymorphonuclear leukocytes
  • spontaneous bacterial peritonitis

ASJC Scopus subject areas

  • General Medicine


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