Episode Summary

Secondary prophylaxis after spontaneous bacterial peritonitis (SBP) has long been considered standard of care—but how strong is the evidence behind it?

In this episode, host Dr. Diana Langworthy is joined by Dr. Ben Webber (hospital medicine physician) and Danielle Luettel (PharmD Candidate 2026) to unpack a contemporary observational study examining outcomes associated with SBP prophylaxis. Together, they explore how historical trials, modern resistance patterns, and guideline recommendations intersect—and where uncertainty still remains.

As care evolves over time, it is important to revisit standard practices to ensure they still make sense. How we revisit them is important and strong internal validity is still what we need to make practice changing claims.

Key Takeaways

• Secondary SBP prophylaxis is rooted in strong historical evidence but largely based on older trials.
• Contemporary observational data raise important questions about mortality benefit and patient selection.
• Guideline recommendations still support prophylaxis, but resistance patterns and evolving microbiology matter.
• Association does not equal causation—especially in retrospective database studies.
• Does this retrospective cohort study rise above the rest? ---> Tune in to find out!

Featured Study

Silvey S, Patel NR, Tsai, SY, et al. Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts. The American Journal of Gastroenterology 120(5):p 1066-1075, May 2025. | DOI: 10.14309/ajg.0000000000003075

Host

Diana Langworthy, PharmD, BCPS Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Guests

Ben Webber, MD Associate Professor, Division of Hospital Medicine Senior Medical Director, Adult Med/Surg University of Minnesota Medical Center – East Bank

Danielle Luetell PharmD Candidate, Class of 2026

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Have a study you'd like us to decode on a future episode? Email [email protected] or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty.

Additional References & Guidelines

• American Association for the Study of Liver Diseases (AASLD)
  • Biggins, Scott W.*,1; Angeli, Paulo2; Garcia‐Tsao, Guadalupe3,4; et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 74(2):p 1014-1048, August 2021. | DOI: 10.1002/hep.31884
• European Associate for the Study of the Liver
  • EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis Journal of Hepatology, Volume 53, Issue 3, 397 - 417
• Foundational Trial for Secondary Prophylaxis
  • Ginés P, Rimola A, Planas R, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990 Oct;12(4 Pt 1):716–724. doi:10.1002/hep.1840120416. PMID:2210673.