If an anaerobic organism is identified on culture the antibiotics most likely to be effective include penicillin G 10,000 u/lb every 4-6 hours IV, metronidazole, or clindamycin 2.5-5 mg/lb BID PO.Ĭorticosteroid therapy is indicated in treatment of chronic active hepatitis, cholangiohepatitis, and immune-mediated hepatopathies. If septicemia or peritonitis occurs in conjunction with liver disease gentamicin 1 mg/lb TID IM or SC is administered for 5-7 days (while monitoring renal function carefully) in conjunction with cephalothin (Keflin, Lilly) at 10 mg/lb TID IV or cefoxitin (Mefoxin) at 10 mg/lb TID to QID IV for broad-spectrum coverage while awaiting culture and sensitivity results. These drugs are either inactivated by the liver, require hepatic metabolism, or are capable of producing hepatic damage. It can be used safely in combination with other antibiotics.Īntibiotics that should be avoided in treatment of liver disease include chloramphenicol, lincomycin, sulfonamides, erythromycin, and hetacillin. Metronidazole is my routine drug of choice for chronic administration in hepatic encephalopathy patients. I sometimes use metronidazole for 2-6 months or longer, in conjunction with maintenance levels of corticosteroids, for liver disease patients that may have both a bacterial and inflammatory component, or that are unable to tolerate required dosage levels of corticosteroids used alone to control the disease. Metronidazole may also be useful in treatment of some chronic inflammatory conditions because it helps reduce cell-mediated immune responses. The combination of metronidazole and an aminoglycoside may be superior for this purpose. It may also be useful in treatment of any liver disorder complicated by inability of the hepatic RE system to clear bacteria absorbed through the portal circulation. Metronidazole's effectiveness against these bacteria could help reduce production of endogenous ammonia, thus benefiting patients with hepatic encephalopathy. Bacteriologic studies have suggested that gram-negative anaerobes are major generators of ammonia from peptides. Metronidazole is highly active against Bacteroides and other anaerobes that exist in high numbers in the colon. Although high hepatic tissue levels are reached with chloramphenicol, the plasma half-life can be prolonged and toxicity may occur in patients with liver disease. Chloramphenicol and tetracycline are alternative choices that are effectively excreted in the bile, however, tetracycline is potentially hepatotoxic. hepatitis from any cause, septicemia) the antibiotics selected generally are directed against intestinal organisms.Īntibiotics routinely used in treatment of patients with liver disease include penicillins (ampicillin 10 mg/lb TID, amoxicillin 10 mg/lb BID), cephalexin (Keflex, Dista) 10 mg/lb TID, enrofloxacin (Baytril) 1.2 - 2.3 mg/lb BID, and metronidazole (Flagyl, Searle) 5-0 mg/lb BID. In cases of compromised hepatic RE function (e.g. The regimen may be modified in accordance with specific information obtained from cultures of bile, hepatic tissue or blood. Cholangitis has several causes, including bacterial invasion, which warrants antibiotic therapy. In hepatic bacterial encephalopathy, antibiotics are used to help reduce colonic bacterial numbers in an effort to decrease ammonia formation. The bactericidal function of the hepatic reticuloendothelial (RE) system may be compromised in hepatic disease, especially if hepatic blood flow or oxygen tension is altered, resulting in septicemia. Antibiotic therapy is indicated for treatment of suppurative hepatitis, cholangiohepatitis and hepatic encephalopathy, and prevention of septicemia.
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