Rethinking Antibiotic Prophylaxis for Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: First, Do No Harm

Antibiotic prophylaxis for spontaneous bacterial peritonitis (SBPPr) in patients with cirrhosis has been considered the standard of care since the 1990s and is currently recommended by several major gastroenterological societies. However, the evidence that supports this practice is weak, and there i...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 80; no. 4; p. 710
Main Authors: Markley, J Daniel, Bajaj, Jasmohan S
Format: Journal Article
Language:English
Published: United States 30.04.2025
Subjects:
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - adverse effects
Antibiotic Prophylaxis - methods
Antimicrobial Stewardship
Bacterial Infections - drug therapy
Bacterial Infections - prevention & control
Humans
Liver Cirrhosis - complications
Peritonitis - complications
Peritonitis - drug therapy
Peritonitis - microbiology
Peritonitis - prevention & control
antimicrobial prophylaxis
gut microbiome
spontaneous bacterial peritonitis
primary prophylaxis
antimicrobial resistance
secondary prophylaxis
ISSN:1537-6591, 1537-6591
Online Access:Get more information
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Summary:Antibiotic prophylaxis for spontaneous bacterial peritonitis (SBPPr) in patients with cirrhosis has been considered the standard of care since the 1990s and is currently recommended by several major gastroenterological societies. However, the evidence that supports this practice is weak, and there is no clear mortality benefit. The unintended consequences of this strategy are not insignificant, both at the patient and population levels. Recent evidence suggests that SBPPr may even cause harm. Since the widespread implementation of SBPPr 3 decades ago, our overall approach to antibiotic use has shifted. We now recognize the growing threat of antimicrobial resistance, the potential harms of antibiotics, and the vital role of antimicrobial stewardship. In light of recent developments and evidence, there is an urgent need for infectious diseases, antimicrobial stewardship, and hepatology leaders to collaborate in development of an updated and cohesive approach to SBPPr.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciaf047