minocycline and Liver-Cirrhosis

Topics: Dinitrochlorobenzene; Hexachlorocyclohexane; Humans; Liver Cirrhosis; Methotrexate; Minocycline; Photochemotherapy; PUVA Therapy; Skin Absorption; Skin Diseases; Skin Pigmentation

Tigecycline belongs to a new class of tetracyclines, the glycylcyclines, less than 20% of which is metabolized in the liver. Twenty-five patients with cirrhosis with varying degrees of functional hepatic reserve (Child-Pugh A, n = 10; B, n = 10; C, n = 5) and 23 healthy adults, matched by age, sex, weight, and smoking habits, received 100 mg of tigecycline infused intravenously over 60 minutes. Serum and urine samples were collected up to 120 hours after dosing. Pharmacokinetic data were derived using noncompartmental methods. The most common treatment-emergent adverse events in healthy volunteers were nausea (56.5%), vomiting (21.7%), and headache (21.7%) and in the patients with cirrhosis, albuminuria (12%). Mean (± 1 SD) tigecycline clearance values were 29.8 ± 11.3 L/h in healthy subjects and 31.2 ± 13.9 L/h (Child-Pugh A), 22.1 ± 9.3 L/h (Child-Pugh B), and 13.5 ± 2.7 L/h (Child-Pugh C) in the patients. A single intravenous dose of tigecycline 100 mg was safe and well-tolerated in patients with cirrhosis with varying degrees of hepatic functional reserve. No adjustment of tigecycline maintenance dosage is warranted in patients with compensated or moderately decompensated cirrhosis; doses should be reduced by 50%, to 25 mg, every 12 hours in patients with severely decompensated disease.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Female; Humans; Infusions, Intravenous; Liver Cirrhosis; Male; Middle Aged; Minocycline; Severity of Illness Index; Tigecycline

Bacterial infections because of multidrug-resistant (MDR) bacteria are spreading worldwide. In patients with advanced liver cirrhosis, healthcare-acquired and hospital-acquired infections are common and are frequently sustained by MDR bacteria. In these settings, tigecycline, a new antibiotic, has been shown to be useful in the treatment of MDR bacteria, and it has been proposed for the treatment of hospital-acquired infections in patients with cirrhosis. Nevertheless, poor data exist on the safety profile of tigecycline in patients with cirrhosis. Here, an experience is reported in a female patient with advanced liver cirrhosis, who developed sepsis by an MDR Stenotrophomonas maltophilia and was treated with tigecycline. She experienced life-threatening side effects consisting of severe coagulopathy with hypofibrinogenaemia and subsequent gastrointestinal haemorrhage. The side effect disappeared after the withdrawal of tigecycline. Therefore, a strict monitoring of coagulation parameters in patients with cirrhosis treated with tigecycline is recommended.

Topics: Adult; Afibrinogenemia; Anti-Bacterial Agents; Blood Coagulation Disorders; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis; Minocycline; Opportunistic Infections; Stenotrophomonas maltophilia; Tigecycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antihypertensive Agents; Hepatitis, Autoimmune; Humans; Hypertension; Immunosuppressive Agents; Liver; Liver Cirrhosis; Lupus Vulgaris; Male; Minocycline

Hepatic hydrothorax is defined as a pleural effusion that arises in patients with cirrhosis of the liver and no cardiopulmonary disease; it is believed to result from peritoneopleural communication through a defect in the diaphragm.. Nine patients underwent thoracoscopic pleurodesis. The diaphragmatic defect was detected and corrected in two cases. In all patients, an argon beam coagulator was applied to the diaphragm surface, which was then completely covered with bioabsorbable prostheses. We then spread 3 ml of fibrin glue on the covered diaphragm and sprinkled 5 KE of OK-432 and 100 mg of minocycline hydrochloride in the thoracic cavity.. All patients showed clinical improvement. The pleural effusion and breathlessness resolved immediately after pleurodesis. There were two recurrences after 1 and 4 months, respectively. One of these patients improved after repeat pleurodesis; the other was treated conservatively.. Our new technique of thoracoscopic pleurodesis is an effective and minimally invasive treatment for patients with refractory hepatic hydrothorax.

Topics: Aged; Diaphragm; Female; Fibrin Tissue Adhesive; Humans; Hydrothorax; Laser Coagulation; Liver Cirrhosis; Liver Cirrhosis, Biliary; Male; Middle Aged; Minimally Invasive Surgical Procedures; Minocycline; Palliative Care; Picibanil; Pleurodesis; Polyglycolic Acid; Recurrence; Reoperation; Surgical Mesh; Thoracoscopy

Management of refractory hepatic hydrothorax is a challenge to physicians in clinical practice. We reported two patients with hepatic hydrothorax, non-alcoholic cirrhosis and rapidly recurring pleural effusion. They failed to improve with diuretics and repeated thoracentesis. Refractory hepatic hydrothorax was successfully treated by minocycline-induced pleural symphysis. After pleurodesis, ventilatory function returned to normal in both patients. No recurrence of pleural effusion was noted. We suggest that minocycline pleurodesis is an alternative treatment for refractory hepatic hydrothorax because it is simple, safe and effective.

Topics: Aged; Anti-Bacterial Agents; Humans; Hydrothorax; Liver Cirrhosis; Lung; Male; Middle Aged; Minocycline; Pleurodesis

Topics: Anti-Bacterial Agents; Bacteria; Disaccharides; Feces; Humans; Lactulose; Liver Cirrhosis; Minocycline; Neomycin; Paromomycin

Two patients had community-acquired Acinetobacter calcoaceticus var anitratus pneumonia. Both patients were alcoholic and one was cirrhotic. One patient died and the other received two weeks of gentamicin therapy and survived. Misinterpretation of the sputum Gram stain delayed diagnosis and institution of proper therapy in both cases. In addition to organisms sensitive to penicillins such as Neisseria or Haemophilus, Acinetobacter must be considered in the differential diagnosis of community-acquired Gram-negative coccobacillary pneumonia.

Topics: Acinetobacter; Acinetobacter Infections; Adult; Alcoholism; Amikacin; Diagnostic Errors; Drug Resistance, Microbial; Female; Gentamicins; Humans; Liver Cirrhosis; Male; Middle Aged; Minocycline; Pneumonia; Sputum; Staining and Labeling; Tobramycin