A 45-year-old male with chronic hepatitis C cirrhosis presents with fever, generalized abdominal pain, and worsening ascites. Paracentesis yields cloudy fluid with an absolute neutrophil count of 340 cells/mm^3. What is the immediate treatment of choice?

Answer and explanation

Correct answer: C. Intravenous cefotaxime and albumin

  1. Step 1: An ascitic fluid absolute neutrophil count (ANC) greater than 250 cells/mm^3 establishes the diagnosis of spontaneous bacterial peritonitis (SBP).
  2. Step 2: The standard empirical antimicrobial therapy is a third-generation cephalosporin, such as intravenous cefotaxime or ceftriaxone, combined with intravenous albumin to reduce the risk of hepatorenal syndrome and mortality.
Answer
Intravenous cefotaxime and albumin.
Why not the others: 'Intravenous furosemide' exacerbates hypovolemia and risks renal failure in decompensated cirrhosis; 'Oral metronidazole' lacks adequate coverage against aerobic gram-negative enteric bacilli causing SBP; 'Therapeutic large-volume paracentesis alone' does not eradicate bacterial infection.

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