SBP OR decompensated Chronic liver disease with sepsis

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

(IV/oral): 7 days

Liaise with Gastroenterology for long-term antibiotic prophylaxis.

Spontaneous Bacterial Peritonitis OR Decompensated Chronic Liver disease with Sepsis unknown source

Therapy

IV Piperacillin / Tazobactam 4,10 4.5g 8 hourly 

Stepping down to:

Oral Co-amoxiclav 625mg 8 hourly


Penicillin allergy  

Oral / IV Ciprofloxacin 1,2,8,9,10,12 500mg / 400mg 12 hourly 
+ IV Vancomycin3

Stepping down to:

Oral Ciprofloxacin1,2,8.9,10,12 500mg 12 hourly 
OR 
Oral Co-trimoxazole2,10,12,13 960mg 12 hourly

Notes:

Spontaneous Bacterial Peritonitis
If Peritoneal white cell count > 500/ mm3 (> 0.5 × 109/L) or neutrophils >250/ mm3 (> 0.25 × 109/L)  

Total duration (IV/oral): 7 days
Liaise with Gastroenterology for long-term antibiotic prophylaxis.

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: January 2024