colistin and Disseminated-Intravascular-Coagulation

A premature neonate with severe Coxsackie B1 hepatitis acquired in utero developed disseminated intravascular coagulation a few days after birth. The neonate did not respond to conventional treatment. Eradication of aerobic gram-negative bacilli (Enterobacteriaceae) from the gut with oral nonabsorbable polymyxin E and tobramycin (selective decontamination of the digestive tract) was followed by clinical improvement; disseminated intravascular coagulation was controlled. After an unstable convalescence, the neonate recovered and was discharged in good general condition. A correlation between oral feeding, gut carriage of Enterobacteriaceae, fecal endotoxin pool, and platelet counts was observed. The eradication of gut carriage of aerobic gram-negative bacilli was associated with a significant decrease of the intestinal endotoxin pool and paralleled the recovery from thrombocytopenia. Selective decontamination is discussed as a method of possible value for controlling systemic endotoxin-induced symptoms in the critically ill with intestinal endotoxemia.

Topics: Administration, Oral; Cefuroxime; Colistin; Coxsackievirus Infections; Disseminated Intravascular Coagulation; Enterovirus B, Human; Gram-Negative Bacteria; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestines; Tobramycin

Polymyxins are known to form complexes with endotoxins and phospholipids. Therefore patients with septicaemia were treated in some studies with polymyxin. We investigated the effect of polymyxin B and E (colistin) on some blood coagulation parameters, spreading of platelets and fibrin polymerisation. With increased concentrations of polymyxin (1, 5, 10, 20, 100 mg%) we found a significant prolongation of prothrombin, partial thromboplastin and TEG reaction times. Spreading of platelets was also reduced. There was, however, no effect on fibrin polymerisation. The coagulation inhibitory effects of polymyxins could be reduced by adding phospholipids as procoagulant. These results indicate: 1. There are anticoagulant effects of polymyxins even in therapeutic doses and therefore it should not be applied in cases of haemorrhagic diathesis or renal insufficiency. 2. In septicaemia the disseminated intravascular coagulation can be prevented because due to consumption of polymyxin, endotoxinaemia persists.

Topics: Anticoagulants; Blood Coagulation; Colistin; Disseminated Intravascular Coagulation; Fibrin; Humans; Partial Thromboplastin Time; Platelet Aggregation; Polymyxin B; Polymyxins; Prothrombin Time

Topics: Adult; Ampicillin; Anemia; Blood Coagulation Tests; Colistin; Disseminated Intravascular Coagulation; Female; Focal Infection, Dental; Hemoglobinuria, Paroxysmal; Heparin; Humans; Injections, Intravenous; Skin Manifestations; Tooth Extraction

Three antimicrobial agents were evaluated as to their ability to neutralize the toxic effects of endotoxin in rabbits. These consisted of two cyclic polypeptides, polymyxin B sulfate and colymycin M (sodium colistimethate), and an aminoglycoside, gentamicin sulfate. Polymyxin B regularly prevented endotoxin-induced leukopenia, thrombocytopenia, and disseminated intravascular coagulation. Colymycin M had similar activity but was not as effective as polymyxin B. Gentamicin demonstrated no neutralizing ability in this study.

Topics: Animals; Colistin; Disseminated Intravascular Coagulation; Endotoxins; Escherichia coli; Gentamicins; Kidney Cortex Necrosis; Leukopenia; Polymyxins; Rabbits; Shwartzman Phenomenon; Thrombocytopenia