What are the guidelines for prophylaxis against SBP in patients with advanced liver disease?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Antibiotics are not routinely offered to prevent spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites .

However, antibiotics may be considered for SBP prophylaxis in specific circumstances:

  • If the person is at high risk of developing SBP due to severe liver disease ,. This includes individuals with an ascitic protein of 15 g per litre or less, a Child–Pugh score of more than 9, or a MELD score of more than 16 .
  • If the consequences of an infection could seriously impact the person's care, such as affecting their wait for a transplant or a transjugular intrahepatic portosystemic stent insertion (TIPS) ,.

When offering antibiotics for SBP prevention, it is important to follow local microbiological advice and continue treatment until the ascites has resolved .

Separately, prophylactic intravenous antibiotics should be offered to people with cirrhosis who have upper gastrointestinal bleeding .

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