# Antibiotic Therapy for treating liver disease



## marjrc (Jan 13, 2007)

I got this from the Canine Liver Health group and thought it might be helpful to some...

The following is about *Antibiotic Therapy for treating liver disease*. 
But it does NOT mention the *possible adverse 
side effects that Flagyl can have on the liver*, and we know this is 
true. So not sure how helpful it is other than showing what 
antibiotics are most often prescribed for dogs with known liver 
disease.

http://www.vin.com/VINDBPub/SearchPB...00/PR00430.htm

"*Antibiotics*

Antibiotic therapy is indicated for treatment of suppurative 
hepatitis, cholangiohepatitis and hepatic encephalopathy, and 
prevention of septicemia. 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.

In hepatic bacterial 
encephalopathy, antibiotics are used to help reduce colonic bacterial 
numbers in an effort to decrease ammonia formation. Cholangitis has 
several causes, including bacterial invasion, which warrants 
antibiotic therapy. The regimen may be modified in accordance with 
specific information obtained from cultures of bile, hepatic tissue 
or blood. In cases of compromised hepatic RE function (e.g. hepatitis 
from any cause, septicemia) the antibiotics selected generally are 
directed against intestinal organisms.

Antibiotics 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- 10 mg/lb BID. 
Chloramphenicol and tetracycline are alternative 
choices that are effectively excreted in the bile, however, 
tetracycline is potentially hepatotoxic. 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.

Metronidazole is highly active against Bacteroides and other 
anaerobes that exist in high numbers in the colon. Bacteriologic 
studies have suggested that gram-negative anaerobes are major 
generators of ammonia from peptides. Metronidazole's effectiveness 
against these bacteria could help reduce production of endogenous 
ammonia, thus benefiting patients with hepatic encephalopathy. 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.

The combination of metronidazole and an 
aminoglycoside may be superior for this purpose. Metronidazole may 
also be useful in treatment of some chronic inflammatory conditions 
because it helps reduce cell-mediated immune responses. 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 is my routine drug of 
choice for chronic administration in hepatic encephalopathy patients. 
It can be used safely in combination with other antibiotics.

Antibiotics that should be avoided in treatment of liver disease 
include chloramphenicol, lincomycin, sulfonamides, erythromycin, and 
hetacillin. These drugs are either inactivated by the liver, require 
hepatic metabolism, or are capable of producing hepatic damage.

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. 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."

[end quote]

http://www.dcavm.org/05sep.html

http://www.petplace.com/drug-library...lex/page1.aspx


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