Liver cirrhosis is one of the commonest conditions which leads to a significant morbidity, multiple hospitalisation and mortality throughout the world. Spontaneous Bacterial Peritonitis (SBP) is one of the prevalent conditions associated with liver cirrhosis and as cites increasing its mortality several folds. These patients are prone to multiple infections owing to subdued immune response. This is due to deficient complement system, and diminished activity of neutrophilic and reticuloendothelial systems. This poor immune system leads to development of SBP and also responsible for its recurrence. The risk rises with previous episode of SBP, low ascitic fluid protein concentration (less than 1.5g/dL), high serum bilirubin (above 2.5 mg/dL) along with impaired renal functions and with gastrointestinal hemorrhage. The most common microbes found in the ascitic fluid are gram-negativeaerobic bacteria and most common isolates are Escherichia coli (E. coli), Klebsiella pneumoniae and thepneumococci. Third generation cephalosporins are the first line agent to treat SBP. Other antimicrobial agents are amoxicillin/clavulanate, ciprofloxacin etc. Prophylactic therapy plays a crucial role in decreasing the chances of infection and themorbidity and mortality associated with this condition. The prophylactic antimicrobial therapyaims to decrease the bacterial contamination of the gut and prevent the seepage of bacteria from the gut to the ascitic fluid. Norfloxacin is most commonly prescribed antimicrobial therapy as lifelong prophylaxis in SBP. Trimethoprim-Sulfamethoxazole is yet another alternative. In view of such high recurrence and morbidity, early diagnosis, treatment and prophylaxis play a crucial role in determining the prognosis of SBP.
