What is the recommended treatment for spontaneous bacterial peritonitis in a patient on peritoneal dialysis?

Spontaneous bacterial peritonitis (SBP) is a serious infection that occurs commonly in patients with cirrhotic liver disease and in individuals on peritoneal dialysis due to the presence of ascitic fluid. The recommended treatment for SBP in this context involves the use of broad-spectrum intravenous antibiotics to effectively cover the most common pathogens, which are typically gram-negative bacteria like Escherichia coli and gram-positive bacteria such as Streptococcus.

Cefepime, a fourth-generation cephalosporin, provides strong coverage against gram-negative organisms, particularly those that may be resistant. When combined with vancomycin, which is effective against gram-positive organisms, this combination addresses the typical bacteria associated with SBP. This dual therapy approach is particularly important in the context of patients receiving peritoneal dialysis, as their risk for multidrug-resistant organisms is heightened. Therefore, the use of cefepime and vancomycin is a clinically appropriate choice for treating SBP effectively.

In contrast to other combinations, the included options such as ceftriaxone and albumin do not offer the same level of comprehensive coverage, particularly against resistant organisms. Similarly, azithromycin and metronidazole are not first-line agents for SBP