scholarly journals Antibiotics and Liver Cirrhosis: What the Physicians Need to Know

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 31
Author(s):  
Caterina Zoratti ◽  
Rita Moretti ◽  
Lisa Rebuzzi ◽  
Irma Valeria Albergati ◽  
Antonietta Di Somma ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Drug Metabolism ◽  
Antibiotic Therapy ◽  
Practical Knowledge ◽  
Liver Parenchyma ◽  
Primary Site ◽  
Narrative Review ◽  
Drug Choice ◽  
Clinical Scenarios ◽  
Ongoing Infection

The liver is the primary site of drug metabolism, which can be altered by a variety of diseases affecting the liver parenchyma, especially in patients with liver cirrhosis. The use of antibiotics in patients with cirrhosis is usually a matter of concern for physicians, given the lack of practical knowledge for drug choice and eventual dose adjustments in several clinical scenarios. The aim of the current narrative review is to report, as broadly as possible, basic, and practical knowledge that any physician should have when approaching a patient with liver cirrhosis and an ongoing infection to efficiently choose the best antibiotic therapy.

scholarly journals Diabetic Foot Care Plan

2000 ◽  
Vol 11 (suppl d) ◽  
pp. 15D-21D
Author(s):  
Gordon Dow ◽  
The Diabetic Foot Care Plan Working Group
Keyword(s):  
Diabetes Mellitus ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Economic Loss ◽  
Care Plan ◽  
Foot Care ◽  
Foot Ulceration ◽  
General Management ◽  
Clinical Scenarios ◽  
Therapeutic Guidelines

Diabetes mellitus is the number one cause of limb loss in North America, and is associated with growing, unacceptable rates of morbidity, mortality and economic loss. Approximately 80% of these amputations are preceded by the development of foot ulceration. Various disciplines have studied the prevention and management of foot ulceration in those with diabetes. The present care plan was constructed to incorporate the important contributions from these disciplines into practical therapeutic guidelines. The care plan has been divided into three basic sections: assessment, general management and antibiotic therapy. Each of these sections is described in detail and borrows heavily from previous Canadian position papers. Application of the care plan is illustrated by multiple diabetic foot clinical scenarios, which have been categorized according to the Wagner classification.

scholarly journals Comparison of the therapeutic effects of hUC-MSC intravenous delivery and intraperitoneal administration of MSCs encapsulated in alginate capsules for the treatment of rat liver cirrhosis

2021 ◽  
Author(s):  
Svitlana Rymar ◽  
Polina Pikus ◽  
Ianina Pokholenko ◽  
Polina Buchek ◽  
Nadiya Shuvalova ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Umbilical Cord ◽  
Therapeutic Potential ◽  
Intraperitoneal Administration ◽  
Liver Parenchyma ◽  
Negative Control ◽  
Human Umbilical Cord ◽  
Therapeutic Effects ◽  
Alginate Capsules ◽  
Therapeutic Properties

Mesenchymal stem cells are the most promising regenerative medicine tool for the treatment of various diseases, including liver disease, although the exact mechanism of their therapeutic action remains unclear. It was found that MSCs are captured by the lungs after systemic transplantation, quickly disappear, and are not detected at the site of injury, but at the same time exhibit an obvious therapeutic effect. Comparison of the MSC efficiency depending on the route of their administration may shed light on the mechanisms involved in the implementation of MSC therapeutic potential. In this work, we compared the therapeutic effects of human umbilical cord MSCs (hUC-MSCs) administered systemically and intraperitoneally in the form of MSCs encapsulated in alginate capsules in a CCl4-induced model of liver cirrhosis in rats. Our study showed that both treatments resulted in liver recovery. MSC transplantation by two different routes led to a decrease in collagen deposition, the disappearance of the fibrous area by the 13th week, and normalization of the morphometric parameters of liver parenchyma cells. The expression of some genes (EGF, alpha SMA, GFAP) which is activated in liver injury, decreased to the level observed in negative control animals. However, a detailed study of liver recovery in dynamics showed that encapsulated MSCs led to faster normalization in several parameters of the liver tissue. Our results showed that human umbilical cord MSCs effectively exhibit their therapeutic properties when using both methods of transplantation, however, intraperitoneal administration of encapsulated MSCs accelerated the process of liver regeneration.

scholarly journals Metabolic Alterations Associated with Early-Stage Hepatocellular Carcinoma and Their Correlation with Aging and Enzymatic Activity in Patients with Viral Hepatitis-Induced Liver Cirrhosis: A Preliminary Study

2020 ◽  
Vol 9 (3) ◽  
pp. 765
Author(s):  
Chung-Man Moon ◽  
Sang Soo Shin ◽  
Suk Hee Heo ◽  
Yong Yeon Jeong
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Lactate Dehydrogenase ◽  
Enzymatic Activity ◽  
Viral Hepatitis ◽  
Potential Risk ◽  
Early Stage ◽  
Liver Parenchyma ◽  
Cirrhotic Liver ◽  
1H Mrs

Liver cirrhosis (LC) can develop hepatocellular carcinoma (HCC). However, noninvasive early diagnosis of HCCs in the cirrhotic liver is still challenging. We aimed to quantify the hepatic metabolites in normal control (NC), cirrhotic liver without HCC, cirrhotic liver with HCC (CLH), and early-stage HCC groups using proton magnetic resonance spectroscopy (1H-MRS) with a long echo-time (TE) and to assess the potential association between the levels of hepatic metabolites in these four groups and aging and enzymatic activity. Thirty NCs, 30 viral hepatitis-induced LC patients without HCC, and 30 viral hepatitis-induced LC patients with HCC were included in this study. 1H-MRS measurements were performed on a localized voxel of the normal liver parenchyma (n = 30) from NCs, cirrhotic liver parenchyma (n = 30) from LC patients without HCC, and each of the cirrhotic liver parenchyma (n = 30) and HCC (n = 30) from the same patients in the CLH group. Generalized estimating equations were used to evaluate potential risk factors for changes in metabolite levels. Potential associations between metabolite levels and age and serum enzymatic activities were assessed by correlation analysis. The levels of lactate+triglyceride (Lac+TG) and choline (Cho) in HCC were significantly higher compared to those in LC and CLH. A potential risk factor for changes in the Lac+TG and Cho levels was age, specifically 60–80 years of age. In particular, the Lac+TG level was associated with a high odds ratio of HCC in males aged 60–80 years. The Lac+TG and Cho concentrations were positively correlated with lactate dehydrogenase and alkaline phosphatase activities, respectively. Our findings suggested that 1H-MRS measurement with a long TE was useful in quantifying hepatic Lac+TG and Cho levels, where higher Lac+TG and Cho levels were most likely associated with HCC-related metabolism in the viral hepatitis-induced cirrhotic liver. Further, the level of Lac+TG in HCC was highly correlated with older age and lactate dehydrogenase activity.

scholarly journals A case of pneumonia and sepsis in cirrhosis as paradigm of the problems in the management of bacterial infections in cirrhosis and of the limitations of current knowledge

2013 ◽  
pp. 209-214
Author(s):  
Manuel Tufoni ◽  
Alessandra Tovoli ◽  
Caterina Maggioli ◽  
Lucia Napoli ◽  
Carmen Serena Ricci ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Hepatic Encephalopathy ◽  
Hepatitis C ◽  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Empirical Antibiotic Therapy ◽  
Increased Risk

Bacterial infections are a major problem in the management of liver cirrhosis. They represent the first precipitating cause of death since patients with cirrhosis carry an increased risk of sepsis, sepsis-induced organ failure and death. Although the clinical presentation is often misleading, the presence of bacterial infection should always be actively searched and ruled out with certainty whenever a cirrhotic patient is admitted to the hospital with an acute clinical deterioration. Major changes in the epidemiology of bacterial infections have also occurred in the last decade making the choice of empirical antibiotic therapy a challenge. We report a paradigmatic case of a 54-year old man with hepatitis C-related cirrhosis admitted to the hospital for worsening of his ascites and onset of hepatic encephalopathy, an excellent example for the difficulties of management of sepsis in cirrhosis and the limits of current knowledge.

The inhibition of drug metabolism by cimetidine in patients with liver cirrhosis

1984 ◽  
Vol 62 (23) ◽  
pp. 1126-1131 ◽  
Author(s):  
R. Gugler ◽  
M. Wolf ◽  
H. -H. Hansen ◽  
J. C. Jensen
Keyword(s):  
Liver Cirrhosis ◽  
Drug Metabolism

scholarly journals GAMBARAN GANGGUAN HEMOSTASIS PADA PENDERITA SIROSIS HATI YANG DI RAWAT DI RSUP PROF.DR.R.D.KANDOU PERIODE AGUSTUS 2013 – AGUSTUS 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Garry G. Saragih ◽  
Bradley J. Waleleng ◽  
Harlinda Haroen
Keyword(s):  
Liver Cirrhosis ◽  
Liver Dysfunction ◽  
Blood Clotting ◽  
Secondary Data ◽  
Liver Parenchyma ◽  
Age Group ◽  
Common Cause ◽  
Bleeding Manifestation ◽  
Cirrhotic Patients ◽  
Hemostatic Disorder

Abstract: Liver cirrhosis is a chronic disease characterized by changes in the structure and architecture of the liver parenchyma resulting in liver dysfunction. One of the liver dysfunction is changes in metabolism of proteins that play a role in blood clotting hemostasis). Therefore, one of the complications often found in liver cirrhosis is bleeding. This study aimed to obtain the profile of hemostatic disorder of cirrchosis patients treated in Prof. Dr. R. D. Kandou Hospital Manado from August 2013 toAugust 2015. This was a retrospective descriptive study using the secondary data of the Medical Record. The results showed that there were 75 patients with liver cirrhosis; 34 (45.7%) had impaired hemostasis. The highest proportion of cirrhotic patients with hemostasis disorder was male (67.6%); age group of 51-65 years (55.8%); the most common cause was HBV infection (35.3%); the most often bleeding manifestation was melena (61.7%); and the most common cause of bleeding was esophageal varices (44.1%), prolongation of PT (86.7%) and of APTT (46.7%). Low level of platelets count occured in 85,2% of patients. Conclusion: Almost half of the patients with liver cirrhosis had hemostasis disorders. Prolongation of PT occurred in most of the patients, however, no significant APTT prolongation was found. Thrombocytopenia frequently occured in patients with liver cirrhosis associated with hemostasis disorders. Keywords: hemostatic disorder, PT, thrombocytopenia, cirrchosis  Abstrak: Sirosis hati adalah penyakit hati kronis dimana terjadi perubahan struktur dan arsitektur dari parenkim hati sehingga hati tidak dapat berfungsi dengan baik. Salah satu fungsi hati yang terganggu ialah metabolisme protein yang berperan dalam mengatur fungsi pembekuan darah (hemostasis). Salah satu komplikasi yang sering dijumpai pada sirosis hati adalah perdarahan. Penelitian inin menggunakan metode retrospektif dengan mengambil data sekunder di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Dari hasil penelitian diperoleh pasien sirosis hati sebanyak 75 orang, dan 34 orang (45,7%) diantaranya mengalami gangguan hemostasis. Proporsi tertinggi pasien sirosis disertai gangguan hemostasis ialah laki-laki (67,6%); kelompok umur 51-65 tahun (55,8%); penyebab terbanyak infeksi HBV (35,3%); manifestasi perdarahan yang sering muncul ialah melena (61,7%) dengan penyebab perdarahan tersering adalah varises esofagus (44,1%); serta pemanjangan PT (86,7%) dan APTT (46,7%). Nilai trombosit dibawah normal (trombositopenia) terjadi pada 85,2% pasien. Simpulan: Hampir setengah pasien sirosis hati mengalami gangguan hemostasis. Pemanjangan PT terjadi pada sebagian besar pasien yang diperiksa sedangkan pemanjangan APTT tidak signifikan. Trombositopenia sering terjadi pada pasien sirosis hati disertai gangguan hemostasis. Kata kunci: Gangguan hemostasis, PT, trombositopenia, sirosis.

scholarly journals Antibiotics in critically ill children—a narrative review on different aspects of a rational approach

2021 ◽  
Author(s):  
Nora Bruns ◽  
Christian Dohna-Schwake
Keyword(s):  
Antibiotic Therapy ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Antibiotic Stewardship ◽  
Narrative Review ◽  
Rational Approach ◽  
Critically Ill Children ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
List Type

Abstract Especially critically ill children are exposed to antibiotic overtreatment, mainly caused by the fear of missing out a severe bacterial infection. Potential adverse effects and selection of multi-drug resistant bacteria play minor roles in decision making. This narrative review first describes harm from antibiotics and second focuses on different aspects that could help to reduce antibiotic overtreatment without harming the patient: harm from antibiotic treatment, diagnostic approaches, role of biomarkers, timing of antibiotic therapy, empiric therapy, targeted therapy, and therapeutic drug monitoring. Wherever possible, we linked the described evidence to the current Surviving Sepsis Campaign guidelines. Antibiotic stewardship programs should help guiding antibiotic therapy for critically ill children. Impact Critically ill children can be harmed by inadequate or overuse of antibiotics. Hemodynamically unstable children with a suspicion of infection should be immediately treated with broad-spectrum antibiotics. In contrast, in hemodynamically stable children with sepsis and organ dysfunction, a time frame of 3 h for proper diagnostics may be adequate before starting antibiotics if necessary. Less and more targeted antibiotic treatment can be achieved via antibiotic stewardship programs.

scholarly journals Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered

2020 ◽  
Vol 8 (24) ◽  
pp. 1709-1709
Author(s):  
Elie Rassy ◽  
Tarek Assi ◽  
Stergios Boussios ◽  
Joseph Kattan ◽  
Julie Smith-Gagen ◽  
...  
Keyword(s):  
Primary Site ◽  
Narrative Review ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Peritoneal Carcinoma ◽  
Primary Peritoneal Carcinoma ◽  
Carcinoma Of Unknown Primary

scholarly journals Antibacterial therapy in the treatment of ascites peritonitis in liver cirrhosis

2018 ◽  
Vol 16 (2) ◽  
pp. 49-56
Author(s):  
Sergey Ya Ivanusa ◽  
Igor Ev Onnitsev ◽  
Alexey V Khokhlov ◽  
Petr N Zubarev ◽  
Alexander V Yankovsky ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Antibiotic Therapy ◽  
Antibacterial Therapy ◽  
Antibacterial Effect ◽  
Decompensated Cirrhosis ◽  
Antibacterial Drug ◽  
Third Generation ◽  
Results Of Treatment ◽  
Main Component ◽  
Third Generation Cephalosporins

Ascites-peritonitis is a severe complication in patients with decompensated cirrhosis. The effectiveness of treatment of ascites of peritonitis depends largely on its early diagnosis. The main component of the treatment of ascites-peritonitis - a complex and targeted antibiotic therapy. Third-generation cephalosporins are recommended as empirical antibiotic therapy. The article presents the results of treatment of ascites peritonitis depending on the method of administration of antibacterial drug - cefbactam. The drug was administered in three ways: intravenous, endolymphatic and combined. The results of pharmacokinetics of the drug depending on the method of administration, as well as the results of the effectiveness of the antibacterial effect in the compared groups of patients. (For citation: Ivanusa SY, Onnitsev IE, Khokhlov AV, et al. Antibacterial therapy in the treatment of ascites peritonitis in liver cirrhosis. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16(2):49-56. doi: 10.17816/RCF16249-56).

Antimicrobial selection policies in the ICU

2016 ◽  
Author(s):  
David L. Paterson ◽  
Yoshiro Hayashi
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Identification ◽  
Antibiotic Resistant ◽  
Antibiotic Selection ◽  
Use Of Technology ◽  
Drug Choice ◽  
Empiric Antibiotic ◽  
Prolonged Antibiotic Therapy ◽  
Antibiotic Dosing ◽  
Selection Of

Antibiotic selection is a crucial drug choice in critically-ill patients. Optimization of empiric antibiotic choice can be gained by knowledge of the site of infection and the probable causative organisms at that site. This should be linked with knowledge of the local epidemiology of antibiotic resistance in the actual intensive care unit housing the patient. Initial empiric antimicrobial choice may need to be broad in order to cover potential antibiotic-resistant pathogens. However, it is important to be prudent in antibiotic strategy since the selection of multiple-resistant organisms by excessively broad or prolonged antibiotic therapy may affect not just the patient undergoing antibiotic therapy, but also other future patients. Selection of appropriate antibiotic regimens can be facilitated by the use of technology such as MALDI-TOF for rapid bacterial identification. Consultation with infectious disease physicians or specialist pharmacists may also be warranted in order to optimize antibiotic dosing, duration of infusion and frequency of administration, so as to meet pharmacodynamics targets linked to improved patient outcome.

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