Explanation: Primary SBP prophylaxis, or prophylaxis in a patient with NO history of SPB, is indicated for upper GI bleeds with cirrhosis.

It typically consists of ceftriaxone 1 g IV every 24 hours for a maximum of 7 days.

Primary SBP prophylaxis may also be used in patients WITH cirrhosis ➕ ascitic protein <1.5 g/dL ➕ one of these:

-Child-Pugh Score >9
-Bilirubin >3 mg/dL
-SCr >1.2 mg/dL
-BUN >25 mg/dL
-Sodium <130 mEq/L

If primary SBP prophylaxis is used outside of an acute GI bleed, duration can be for hospitalization or potentially until ascites resolves. Commonly used medications are:
-TMP/SMX
-Ciprofloxacin or norfloxacin
-Rifaximin

Primary SBP prophylaxis isn’t for everyone, but in appropriate patients with cirrhosis, it is associated with ⬇️ 1 year mortality.