minocycline and Liver-Diseases

The pharmacology, spectrum of activity, pharmacokinetics, clinical efficacy, adverse events, dosage and administration, drug interactions, and place in therapy of tigecycline are reviewed.. Tigecycline is the first of a new class of antimicrobials, the glycylcyclines, to receive approved labeling from the Food and Drug Administration. Similar to tetracyclines, glycylcyclines contain the central four-ring carbocyclic skeleton, with a substitution at the D-9 position. This substitution confers expanded broad-spectrum activity and defense against antimicrobial efflux pumps and ribosomal protection mechanisms. Tigecycline covers a broad spectrum of gram-positive (including resistant isolates), gram-negative (including extended-spectrum beta-lactamase producing organisms), and anaerobic pathogens. It does not exhibit activity against Pseudomonas aeruginosa and Proteus species. Clinical efficacy has been demonstrated in complicated skin and skin structure infections and intraabdominal infections. Tigecycline is administered intravenously and exhibits linear pharmacokinetics. The drug does not undergo extensive metabolism and works independently of the cytochrome P-450 isoenzyme system and therefore does not affect medications metabolized by these enzymes. Tigecycline is administered as a 100-mg i.v. loading dose followed by 50 mg i.v. every 12 hours. Hepatic dosage adjustment is necessary for severe disease; however, no dosage adjustments are necessary for patients with renal impairment.. Tigecycline is an alternative agent available for the treatment of resistant gram-negative and gram-positive infections, especially in patients with a history of a penicillin allergy or antimicrobial-related toxicities.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Interactions; Drug Resistance, Multiple, Bacterial; Humans; Kidney Diseases; Liver Diseases; Minocycline; Tigecycline

Prior to the era of laparoscopic surgery, open surgical deroofing was considered to be the most appropriate therapy for uncomplicated simple hepatic cysts. Recently, there have been a number of reports of successful laparoscopic fenestration of simple hepatic cysts. Simple aspiration of these cysts is associated with a high recurrence rate. Cyst sclerosis with alcohol and, more recently, minocycline hydrochloride have been found to be effective in their management. So far there have been no trials comparing laparoscopic deroofing with sclerotherapy. A lack of consensus in their management results in considerable confusion and difficulty in deciding the optimum form of therapy.. A systematic review of articles on the subject appearing in journals in the English language was conducted using the Medline database and by cross-referencing.. Both laparoscopic deroofing and cyst sclerosis have been found to be effective in partial or complete obliteration of the cyst and in the relief of symptoms produced by the cyst. It is essential to rule out cystadenoma, malignancy, biliary communication and infection prior to treating these cysts. Alcohol/minocycline based sclerotherapy has the advantage of being associated with a lower incidence of complications. Surgery is indicated if it is difficult to rule out the above mentioned conditions, in the presence of biliary communication, in those cysts where sclerosis has been ineffective and in cases of recurrence. The choice between open and laparoscopic surgery depends on the location of the cysts within the liver parenchyma.

Topics: Cysts; Drainage; Ethanol; Humans; Laparoscopy; Liver Diseases; Minocycline; Sclerosing Solutions; Sclerotherapy

Drugs and other chemical toxins account for less than 5% of cases of jaundice or acute hepatitis and fewer cases of chronic liver disease, but they are an important cause of more severe types of hepatic injury. Drug reactions produce an array of hepatic lesions that mimic all known hepatobiliary diseases; this poses a diagnostic challenge for physicians and pathologists. Diagnosis of drug-induced hepatic injury is circumstantial, with positive rechallenge being the only factor that unequivocally implicates a particular agent. Nonetheless, other aspects of the temporal relationship between drug ingestion and adverse reaction, exclusion of other diseases, the presence of extrahepatic features of drug hypersensitivity and some findings on liver biopsy can lend support to the diagnosis. Some of these issues will be explored in this review by considering contemporary paradigms of drug-induced hepatic injury. Factors that predispose to dose-dependent hepatic injury will be considered in relation to acetaminophen, an example of acute hepatotoxicity, and methotrexate, an agent that can produce hepatic fibrosis. Flucloxacillin will be discussed as an example of drug-induced cholestatic hepatitis often associated with prolonged cholestasis and the vanishing bile duct syndrome. Minocycline and diclofenac will be mentioned as two drugs for which drug hepatitis is an exceedingly rare complication. Finally, the evidence that Chinese herbal medicines can be hepatotoxic will be reviewed.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antimetabolites, Antineoplastic; Azathioprine; Chemical and Drug Induced Liver Injury; Diclofenac; Drugs, Chinese Herbal; Floxacillin; Humans; Immunosuppressive Agents; Liver Diseases; Minocycline; Penicillins

This paper describes ultrasonically-guided infusion of minocycline hydrochloride solution (MINO infusion therapy) in benign nonparasitic cysts of the liver. MINO infusion therapy was performed in 7 large hepatic cysts and successful results were obtained in 6 lesions. The infusion procedure in the initial 4 hepatic cysts a 7 Fr catheter was placed into the cyst and MINO solution was left in the cyst according to the procedure of ethanol infusion therapy. In the most recent 2 cases the cyst was punctured with a 21G needle, washed with physiologic saline and then infused MINO solution without placement of an indwelling drainage tube. This modified procedure is simple and safe and also yields a good therapeutic result. MINO infusion therapy for benign hepatic cyst is very useful and the modified procedure can be performed safely in elderly patients and in patients with several complications.

Topics: Adult; Aged; Aged, 80 and over; Cysts; Female; Humans; Injections, Intralesional; Liver Diseases; Middle Aged; Minocycline

Minocycline hydrochloride (MINO) at a dose of 500 mg (in principle) was injected into each of 11 hepatic cysts/10 cases (mean maximum diameter: 12.6 cm) that exhibited symptoms or a tendency toward growth by percutaneous transhepatic one puncture method, and the relation between therapeutic efficacy and pH of cystic fluid was examined. The efficacy was evaluated by abdominal CT after 3 months, and when a shrink of 50% or more in the maximum diameter was observed, it was judged as marked response. Marked effect was observed in 9 lesions of 11 (82%). This MINO injection therapy by one puncture method is very safe, simple and useful. Reduction in intra-cystic pH was not always related to the therapeutic efficacy, so involvement of cytotoxicity of MINO was suggested in degenerating the cystic epithelial cells.

Topics: Adult; Aged; Cysts; Female; Humans; Injections, Intralesional; Liver Diseases; Male; Middle Aged; Minocycline; Treatment Outcome

Hepatic cysts are not rare but usually are asymptomatic; however, large ones sometimes show clinical manifestations. Treatment of a solitary hepatic cyst by one-shot instillation of minocycline chloride is reported here; 500 mg of minocycline chloride was instilled into the hepatic cyst, 11 cm in diameter, through a percutaneous transhepatic cholangiography needle under ultrasound guidance. After 5 weeks, the cyst had decreased in size to 5 cm. Five months later, the cyst could not be detected by diagnostic imaging. Fifteen months after the treatment, no reaccumulated fluid was observed. Ultrasound-guided percutaneous one-shot instillation of minocycline chloride seems to be a safe, easy, and useful procedure for treating a hepatic cyst.

Topics: Cysts; Female; Humans; Injections, Intralesional; Liver Diseases; Middle Aged; Minocycline

We describe the spontaneous rupture of a simple hepatic cyst. A 62-year-old woman was admitted for right upper quadrant pain of sudden onset. The patient denied a history of abdominal trauma. Computed tomography of the abdomen showed a 13-cm-diameter solitary hepatic cyst in the right lobe. Part of the cyst surface was irregular, and the internal echo was heterogeneous. Retained fluid was detected under the liver capsule. Ten days after admission, computed tomography revealed that the volume of fluid retained under the liver capsule had decreased but that the hepatic cyst had enlarged again. The patient was referred to our hospital for further evaluation and treatment. Physical examination revealed mild right upper quadrant pain, but no signs or symptoms of peritonitis or abnormalities of the chest or heart. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Brown serous fluid was aspirated. After the removal of approximately 1,000 mL of fluid, contrast medium was injected to check for communications between the cyst and the biliary tree and to document the absence of leakage into the peritoneal cavity. After complete aspiration of the cyst fluid, 200 mg of minocycline hydrochloride dissolved in 10 mL of saline was injected into the cyst, and the catheter was flushed with 10 mL of saline (total volume of saline, 20 mL). The catheter was then clamped for 30 minutes. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was injected daily for 7 days, and the catheter was removed. There has been no evidence of recurrence after 2 years.

Topics: Anti-Bacterial Agents; Bromhexine; Cysts; Drainage; Female; Humans; Injections, Intralesional; Liver Diseases; Middle Aged; Minocycline; Rupture, Spontaneous; Treatment Outcome

The authors describe the case of a small liver cyst (2 cm in diameter) causing obstructive jaundice that was treated with aspiration and therapeutic sclerosis. The procedure was performed with use of a microcatheter and wire system to access the cyst, which was injected with minocycline hydrochloride. At present, 9 months after treatment, the levels of hepatobiliary enzymes are within normal ranges, and no sign of cyst regrowth has been detected on imaging.

Topics: Aged; Catheterization; Catheters; Cholangiopancreatography, Endoscopic Retrograde; Combined Modality Therapy; Cysts; Drainage; Equipment Design; Female; Humans; Injections; Jaundice, Obstructive; Liver Diseases; Miniaturization; Minocycline; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome

We describe the spontaneous rupture of a simple hepatic cyst associated with a benign course. A 64-year-old woman was admitted for right upper quadrant pain. The patient denied a history of abdominal trauma. Abdominal computed tomography (CT) showed a huge solitary hepatic cyst (diameter, 10 cm) in the right lobe. Part of the cyst surface was irregular, and the interior was heterogeneous on ultrasonography. Fluid retention was detected under the liver capsule. Spontaneous rupture of a nonparasitic hepatic cyst was suspected. The patient was admitted to our hospital for further evaluation and treatment. Examination of the abdomen revealed right upper quadrant pain but no signs or symptoms of peritonitis. One week after admission, CT revealed that the volume of fluid retained under the liver capsule had decreased. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Serous, brown fluid was aspirated. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was given daily by intravenous injection for 7 days. The catheter was then removed. There has been no evidence of recurrence after 1 year.

Topics: Contrast Media; Cysts; Female; Humans; Liver; Liver Diseases; Middle Aged; Minocycline; Rupture, Spontaneous; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

A 64-year-old man with a 9.0 cm benign hepatic cyst near the hepatic hilum presented with obstructive jaundice caused by the compression of the hepatic ducts. The cyst was aspirated percutaneously, and minocycline hydrochloride was instilled as a sclerosant through a catheter inserted into the cyst. The cyst gradually became smaller, relieving the obstructive jaundice. There were no complications or side-effects. The instillation of minocycline hydrochloride is a useful alternative to ethanol instillation for treating benign hepatic cysts, even when the cyst is causing obstructive jaundice.

Topics: Administration, Cutaneous; Catheterization; Cysts; Drainage; Humans; Jaundice, Obstructive; Liver Diseases; Male; Middle Aged; Minocycline; Tomography, X-Ray Computed

The current study presents the long-term results of multiple minocycline hydrochloride (MINO) injections for the treatment of symptomatic solitary hepatic cyst.. From 1989 to 1998, nine patients were referred for the treatment of a symptomatic solitary hepatic cyst, comprising two males and seven females aged between 41-72 years (mean 58.2 years). The chief complaint in all cases was upper abdominal discomfort or pain. Mean cyst diameter was 14.1 +/- 2.3 cm. After insertion of an 8 or 9-French catheter into the cyst, 200 mg of MINO in 10 mL saline was injected and the catheter was flushed with 10 mL saline, for a total of 20 mL saline. The catheter was then clamped for 30 min. MINO injection was performed daily for 7-8 days, after which time the catheter was removed.. One patient complained of moderate right subscapular pain immediately after the injection, and one patient complained of pain at the site of catheter insertion. Patients were followed for 42-153 months (mean 85 months). Cyst regression without recurrence was documented in all patients.. Multiple injections of MINO are safe, definitive treatments for symptomatic solitary hepatic cyst.

Topics: Adult; Aged; Anti-Bacterial Agents; Cysts; Drainage; Female; Follow-Up Studies; Humans; Injections, Intralesional; Liver Diseases; Male; Middle Aged; Minocycline; Sclerosing Solutions; Sclerotherapy; Ultrasonography

Topics: Aged; Anti-Bacterial Agents; Bile Duct Diseases; Constriction, Pathologic; Cysts; Humans; Injections, Intralesional; Liver Diseases; Male; Minocycline

To assess the efficacy of percutaneous minocycline hydrochloride sclerotherapy in symptomatic hepatic cysts.. From November 1992 to June 1994, seven of eight consecutive adults with large symptomatic hepatic cysts (diameter, 55-130 mm) were treated with a single intracystic injection of minocycline hydrochloride in an ambulatory procedure. Five patients had a solitary cyst, and two had polycystic liver disease. The target cyst was punctured under ultrasound guidance and local anesthesia with a 22-gauge Chiba needle. Half of the cyst content was aspirated before injection of 100-500 mg of minocycline hydrochloride diluted in 5-25 mL of saline. The minocycline hydrochloride was left in the cyst at the end of the procedure.. After a mean follow-up of 28 months (range, 24-42 months), all five patients with solitary cysts were asymptomatic and four had documented complete cyst regression; the two patients with multiple hepatic cysts showed only transient clinical improvement.. Single-shot injection of minocycline hydrochloride is an effective treatment for symptomatic solitary hepatic cysts but is less effective in polycystic liver disease.

Topics: Anti-Bacterial Agents; Cysts; Drainage; Female; Follow-Up Studies; Humans; Injections, Intralesional; Liver Diseases; Male; Middle Aged; Minocycline; Prospective Studies; Radiography; Sclerotherapy; Time Factors; Ultrasonography

Topics: Aged; Aged, 80 and over; Cysts; Female; Humans; Injections, Intralesional; Liver Diseases; Middle Aged; Minocycline

We report a case of obstructive jaundice caused by a large hepatic cyst which was successfully treated by percutaneous drainage and instillation of minocycline hydrochloride. An 88-year-old man presented with obstructive jaundice and upper abdominal fullness. Abdominal CT and ultrasonography revealed a large hepatic cyst and intrahepatic bile duct dilatation. After the percutaneous drainage of the cyst, minocycline hydrochloride was instilled as a sclerosant via a catheter into the cyst cavity. Liver enzyme levels returned to normal and the jaundice disappeared. Nine months after the treatment, the large cyst and dilatation of the intrahepatic bile duct had disappeared. The patient has remained healthy without symptoms.

Topics: Aged; Aged, 80 and over; Cholestasis, Intrahepatic; Cysts; Drainage; Humans; Instillation, Drug; Liver Diseases; Male; Minocycline; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Cysts; Female; Humans; Liver Diseases; Minocycline; Polycystic Kidney Diseases; Sclerotherapy

Nine patients with 16 symptomatic nonneoplastic congenital hepatic cysts were treated prospectively by ultrasonically guided percutaneous minocycline hydrochloride injection, and the usefulness of this treatment was evaluated. Seven of the patients had multiple hepatic cysts, and two solitary cysts. All the patients were women, ranging in age from 36 to 81 years. After cystic fluid had been aspirated with a 21-gauge PTC needle, minocycline hydrochloride was injected into all the cysts. The minocycline hydrochloride was dissolved in saline at a concentration of 200 mg in 9 ml, and mixed with 1 ml of 2% mepivacaine hydrochloride. The total quantity of minocycline hydrochloride injected varied from 100 mg to 1200 mg per hepatic cyst, depending on its size. Total or subtotal regression of the cysts was observed in all patients during follow-up periods ranging from 15 to 35 months. Seven patients became symptom-free, one showed symptom reduction, and one showed no change in symptoms. Minor side effects, eg, transient abdominal pain, slight right shoulder pain, and temperature elevation, were noted in three patients respectively. On the basis of these results, we conclude that ultrasonically guided percutaneous minocycline hydrochloride injection is useful for the treatment of symptomatic hepatic cysts.

Topics: Adult; Aged; Aged, 80 and over; Cysts; Female; Humans; Injections; Liver Diseases; Middle Aged; Minocycline; Prospective Studies; Punctures; Ultrasonography, Interventional

We present a successfully treated case of a multi-septated massive hepatic cyst with repeated injection of minocycline hydrochloride (MINO). A 57-year-old Japanese female complaining of right back pain, hypochondralgia and hypertension had a multi-septated massive hepatic cyst, 25 cm in diameter. Multiple cysts of various sizes were also seen in liver and kidneys. In order to reduce the size of the massive hepatic cyst to relieve the complaints, we performed the reduction therapy of the cyst. After a pig tail catheter was inserted into the cyst, the cystic fluid was aspirated and then a total of 3900 mg of MINO was injected. Red-brownish, serous cystic fluids were obtained. Cytology and bacterial culture were negative, but the LDH (3, 336 IU/l) and CA19-9 (751,500 U/l) concentrations were very high. After the 9 series of the therapy, the cyst was minified on CT and the patient's symptoms were relieved. Furthermore high blood pressure was improved. Thus, the therapy of size-reduction for a massive hepatic cyst is revealed to be very safe and useful.

Topics: Cysts; Female; Humans; Hypertension; Injections; Liver Diseases; Middle Aged; Minocycline

Topics: Aged; Cysts; Humans; Injections, Intralesional; Liver Diseases; Male; Minocycline; Tetracyclines

Minocycline hydrochloride hepatotoxic effect occurred in one patient. Unlike the usual histologic features of tetracycline-induced hepatic injury, fatty metamorphosis was predominantly macrovesicular . The patient recovered when drug therapy was withdrawn. Close observation of liver function variables is recommended in patients treated with high parenteral doses of minocycline, particularly in cases of pregnancy or renal disease.

Topics: Acute Disease; Chemical and Drug Induced Liver Injury; Female; Humans; Liver; Liver Diseases; Middle Aged; Minocycline; Tetracyclines