Therapeutic efficacy of vancomycin hydrochloride, a nonabsorbable antibiotics, on intractable (lactulose resistant) chronic hepatic encephalopathy in cirrhotic patients.

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概要

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• Vancomycin hydrochloride (VCM), a nonabsorbable antibiotics, which is effective against anaerobic but ineffective against aerobic gram negative rods, was administered to five cirrhotic patients with intractable portal-systemic encephalopathy (PSE) who were resistant to oral lactulose administration and develop hepatic encephalopathy in spite of the long term administration of the drug, and changes in clinical features, blood ammonia levels, electroencephalograms, and in faecal bacterial flora were examined. VCM was also administered to one cirrhotic patients in whom the lactulose administration had to be discontinued on account of the severe diarrhea which had developed during administration of the drug, even in a small amount of only 10ml per day.Clinical features of hepatic encephalopathy disappeared in all cases, and electroencephalogram showed marked improvements. The study of faecal bacterial flora showed that the anaerobic gram-negative rods (chiefly Bacteroids spp) was markedly decreased to 103-6 counts per gram of stool during VCM administration, in contrast to 108-9 counts in the periods of lactulose administration. On the other hand, aerobic gram-negative bacilli counts remained in the same range of 106-109 per gram of stool in both periods of administration of lactulose and vancomycin. With regard to the correlation between ammonia levels and anaerobic gram-negative rods (chiefly Bacteroides spp), the blood ammonia levels were falling markedly with the decrease in the bacteria as the results of VCM administration. It is concluded that VCM is effective to the intractable PSE who are resistant to oral lactulose administration.

• 財団法人 日本消化器病学会の論文

著者

• 多羅尾 和郎

  川崎協同病院・内科(現神奈川県立がんセンター)

• 野本 哲夫

  汐田病院内科

• 林 和弘

  衣笠診療所内科

• 苅部 ひとみ

  汐田病院内科

• 池田 俊夫

  衣笠診療所内科

• 桜井 彰

  衣笠診療所内科

• 土屋 豊一

  衣笠診療所内科

• 伊東 達郎

  衣笠診療所内科

• 岡田 哲郎

  衣笠診療所内科

関連論文

• アルコール性肝障害に及ぼす社会的背景
• Therapeutic efficacy of vancomycin hydrochloride, a nonabsorbable antibiotics, on intractable (lactulose resistant) chronic hepatic encephalopathy in cirrhotic patients.

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