cefotaxime and Liver-Cirrhosis--Alcoholic

Patients with established cirrhosis are at increased risk of sepsis. Bacterial infections are a frequent cause of morbidity and mortality in patients with advanced liver disease. Mortality for patients admitted to hospital with bacterial infection is approximately 30%, whereas the development of septic shock and multiorgan failure is associated with a mortality of 70-100%. Activation of the hypothalamic-pituitary-adrenal axis is an important feature of a patient's response to severe sepsis and major trauma. An inadequate adrenal response with suboptimal cortisol production has been recognized in patients with septic shock. Patients with septic shock and adrenal insufficiency have reduced response to vasoconstrictor agents, higher rates of refractory shock and high mortality rates. An improvement in survival with administration of hydrocortisone in patients with septic shock and an inadequate adrenal response has been demonstrated. In a more recent study, however, there was no survival benefit in septic shock though reversal of shock was faster with hydrocortisone administration. Recently, adrenal insufficiency has been demonstrated in patients with severe liver disease such as acute liver failure, acute on chronic liver failure, recent liver transplantation and cirrhosis irrespective of the presence of sepsis. Nevertheless survival benefit with administration of hydrocortisone has only been demonstrated in patients with cirrhosis and septic shock. A case report of a patient with cirrhosis and adrenal insufficiency is presented with a review of the literature.

Topics: Adrenal Insufficiency; Cefotaxime; Female; Humans; Hydrocortisone; Liver Cirrhosis, Alcoholic; Lypressin; Middle Aged; Multiple Organ Failure; Norepinephrine; Severity of Illness Index; Shock, Septic; Terlipressin; Vasoconstrictor Agents

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Esophageal and Gastric Varices; Gentamicins; Humans; Ligation; Liver Cirrhosis, Alcoholic; Male

Spontaneous infection of ascitic fluid with Salmonella typhimurium is very rare and exhibits uncommon features.. A Child-Pugh C cirrhotic 47 year-old woman was hospitalised for fever and coma. Norfloxacin 400 mg per day had been introduced three months earlier as secondary prophylaxis for spontaneous bacterial peritonitis. A spontaneous bacterial peritonitis was diagnosed, and an intravenous broad-spectrum antibiotic therapy was started (cefotaxime 1 g/8h). Bacteriologic samples isolated Salmonella typhimurium in ascites, blood and stools; Escherichia coli sensitive to norfloxacin in blood and Escherichia coli resistant to norfloxacin but sensitive to cefotaxime in urine. Despite the initial regression of the hepatic encephalopathy and the decrease in fever, the patient died twenty days after admission to hospital.. This observation is exceptional because of the simultaneous presence of Salmonella typhimurium in ascites, blood and stools. It underlines the features of spontaneous Salmonella bacterial peritonitis: rare, occurring in immuno-suppressive diseases, virulent despite sensitivity to third generation cephalosporines and of often poor prognosis. Compliance to norfloxacin prophylaxis in cirrhotic patients is a real problem, since in the case of poor compliance such patients are exposed both to sensitive norfloxacin bacteria, and to resistant norfloxacin bacteria selected by the norfloxacin prophylaxis.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Ascitic Fluid; Blood; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Liver Cirrhosis, Alcoholic; Middle Aged; Norfloxacin; Peritonitis; Salmonella Infections; Salmonella typhimurium; Time Factors; Urine

Spontaneous bacterial peritonitis is a well known complication in cirrhotic patients with ascites. The etiological spectrum is broad. We report a case of spontaneous bacterial peritonitis due to Plesiomonas shigelloides.

Topics: Cefotaxime; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Peritonitis; Plesiomonas

We have compared in two separate studies the kinetics of ceftriaxone and cefotaxime in 8 cirrhotic patients with ascites and 8 control subjects after a single 20 min intravenous infusion of 1 g of each drug. The apparent volumes of distribution (Vz) were found to be significantly higher in cirrhotics than in control subjects (0.87, versus 0.49, l.kg-1, for cefotaxime and 0.23 versus 0.13 for ceftriaxone). The elimination kinetics of ceftriaxone were similar in the two groups. In contrast, the total and non-renal clearances of cefotaxime were reduced in cirrhotic patients. The two drugs rapidly entered the ascitic fluid. Peritoneal concentrations of ceftriaxone were higher than 7 micrograms.ml-1 from the second hour after the infusion and were 8.9 micrograms.ml-1 at 24 h. Peritoneal concentrations of cefotaxime were higher than 4 micrograms.ml-1 from 0.5 to 8 h after the infusion.

Topics: Ascites; Cefotaxime; Ceftriaxone; Female; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Peritoneal Cavity

Topics: Ascitic Fluid; Cefotaxime; Cephalosporins; Female; Half-Life; Humans; Liver Cirrhosis, Alcoholic; Male