Background Spontaneous bacterial peritonitis prophylaxis (SBPPr)-related practices are evolving, with recent studies showing almost half of potential subjects not being initiated on it.

Aim Determine practice dilemmas regarding SBPPr among US-based hepatology providers.

Method A questionnaire regarding primary and secondary SBPPr using quantitative and qualitative (open-ended) approaches was sent to US-based hepatology providers electronically.

Results 113 clinicians (86% physicians, 73% academic centers) responded. 54% started Primary and 72% secondary SBPPr in 50% of eligible patients. However, the issues related to antimicrobial resistance (AMR) and ineffectiveness lead to SBPPr usage variations and restrictions on a patient-specific basis. Most respondents (>70%) would withdraw/not initiate SBPPr with data regarding ineffectiveness and harms. Open-ended answers showed that most believed newer trials to reduce reliance on weaker older evidence are needed.

Conclusion A survey of US-based hepatologists demonstrates a major dilemma between usual care of SBPPr versus not initiating/withdrawing SBPPr that needs newer randomized trials.

The authors have declared no competing interest.

This study did not receive any funding

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