Clinical recommendation	Evidence rating	References
First-line treatment of patients with cirrhotic ascites consists of sodium restriction (i.e., no more than 2,000 mg per day) and diuretics (e.g., oral spironolactone [Aldactone] and furosemide [Lasix]), as well as complete abstention from alcohol.	A	3
TIPS should be considered in patients with refractory ascites who may require a transplant, whereas a peritoneovenous shunt should be considered in patients with refractory ascites who are not candidates for paracenteses, transplant, or TIPS.	B	3
Patients with ascitic fluid polymorphonuclear leukocyte counts of 250 cells per mm3 or greater should receive empiric antibiotic therapy (e.g., cefotaxime [Claforan] 2 g intravenously every eight hours) and albumin (1.5 g per kg body weight within six hours of detection and 1 g per kg on day 3) to prevent spontaneous bacterial peritonitis.	A	3
Patients who survive an episode of spontaneous bacterial peritonitis should receive long-term antibiotic prophylaxis with norfloxacin (Noroxin) or trimethoprim/sulfamethoxazole (Bactrim, Septra). Patients with gastrointestinal hemorrhage and cirrhosis should receive norfloxacin or trimethoprim/sulfamethoxazole twice daily for seven days.	A	3
Propranolol (Inderal) at a dosage of 40 mg twice daily is recommended for pharmacologic prophylaxis of variceal bleeding, increasing to 80 mg twice daily if necessary or a dosage titrated to a 25 percent reduction in pulse rate.	B	9,15,16
An early referral to a transplant subspecialist is recommended for potential transplant recipients to allow time for patients, families, referring physicians, and transplant centers to meet and identify any potential problems.	C	28