Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections

✍ Scribed by Josefina Felisart; Antoni Rimola; Vicente Arroyo; Rosa M. Perez-Ayuso; Enrique Quintero; Pere Gines; Joan Rodes

• Publisher: John Wiley and Sons
• Year: 1985
• Tongue: English
• Weight: 731 KB
• Volume: 5
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840050319

✦ Synopsis

We compared the effectiveness and incidence of nephrotoxicity of ampicillin-tobramycin and cefotaxime in 73 cirrhotics who had severe bacterial infection. Most of these patients had spontaneous peritonitis and/or bacteremia. Patients were randomly allocated into two groups. Group I included 36 patients treated with ampicillin-tobramycin and Group I1 comprised 37 patients treated with cefotaxime. Patients from both groups were similar with respect to clinical data, standard liver and renal function tests, types of infection and isolated organisms. Ninety-two per cent of bacteria isolated in Group I and 98% of those isolated in Group I1 were susceptible in vitro to ampicillin-tobramycin and to cefotaxime, respectively. Ampicillin-tobramycin cured the infection in 56% of Group I patients, and cefotaxime in 85% of Group I1 patients (p c 0.02). Five patients treated with ampicillin-tobramycin, and none treated with cefotaxime developed superinfections (p = 0.024). Nephrotoxicity (impairment of renal function associated with an increase of urinary &-microglobulin to over 2,000 p g per liter) occurred in two patients in Group I and none in Group 11. These results suggest that broad-spectrum cephalosporins should be considered as first choice antibiotics in cirrhotic patients with severe infections.