Spontaneous bacterial peritonitis prophylaxis

Long-term oral antibiotic prophylaxis in cirrhotic patients with ascites at high risk: after a prior SBP episode, with low ascitic protein (below 15 g/L) and concurrent renal/hepatic decompensation, and with variceal bleeding.

ICD-10 K65.01 drug

Also known as: SBP prophylaxis, Long-term antibiotic prophylaxis in cirrhosis

Drugs used for this condition

BNorfloxacinFirst line · Second-generation fluoroquinoloneNorfloxacin 400 mg daily is the first-line agent for secondary SBP prophylaxis in cirrhotic patients with ascites after a prior SBP episode. AASLD 2021 and EASL 2018 endorse this recommendation. Primary prophylaxis is justified with low ascitic protein (below 15 g/L) and concurrent renal or hepatic dysfunction. The 2009 Cochrane review showed a 50–60% reduction in SBP risk and all-cause mortality. In light of fluoroquinolone risks per FDA 2018 and EMA 2019, prophylaxis duration and patient status are reassessed every 3–6 months.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit