Does Antibiotic Prophylaxis After Spontaneous Bacterial Peritonitis Prevent Recurrence?

Professional society guidelines recommend secondary prophylaxis with ciprofloxacin or trimethoprim/sulfamethoxazole after initial episodes of spontaneous bacterial peritonitis (SBP) for all patients with cirrhosis (NEJM JW Gen Med Nov 1 2021 and Hepatology 2021; 74:1014). This recommendation is based on trial data from the 1990s, but subsequent changes in the microbiology of SBP and rising antibiotic resistance have called this strategy into question. To address this practice in more-contemporary populations, U.S. researchers analyzed administrative data from 11,300 inpatients and outpatients from two cohorts (i.e., U.S. veterans and commercially insured patients) who survived initial episodes of SBP.

Key findings were as follows:

• About half …