title: An open, comparative trial of aztreonam with vancomycin and gentamicin with piperacillin in patients with fulminant hepatic failure.
abstract: Fifty patients admitted with fulminant hepatic failure and clinically suspected infection were allocated to receive either aztreonam and vancomycin or piperacillin and gentamicin as first line treatment. Fourteen patients died within 48 h of admission and were excluded from the analysis. Of the remaining 36 patients, 16 received aztreonam/vancomycin and 20 piperacillin/gentamicin. There were 18 episodes of infection in the aztreonam/vancomycin group and 24 in the piperacillin/gentamicin group (P = not significant). The most frequent bacterial pathogen was Staphylococcus aureus. Fungal infection developed in 13 patients (nine in the aztreonam/vancomycin group and four in the piperacillin/gentamicin group; P = not significant). Death attributed to infection occurred in 4 (25%) of 16 patients receiving aztreonam/vancomycin and 4 (20%) of 20 receiving piperacillin/gentamicin (P = not significant). Thirteen patients (three in the aztreonam/vancomycin group and ten in the piperacillin/gentamicin group) had clinical and microbiological improvement without addition or substitution of other antibiotics. No side-effects attributed to the study drugs were recorded.
authors.affiliation: Institute of Liver Studies, King's College School of Medicine and Dentistry, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Rolando
authors.forename: J J
authors.initials: JJ
authors.lastname: Wade
authors.forename: E
authors.initials: E
authors.lastname: Fagan
authors.forename: J
authors.initials: J
authors.lastname: Philpott-Howard
authors.forename: M W
authors.initials: MW
authors.lastname: Casewell
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D001398:Aztreonam / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005839:Gentamicins; D014640:Vancomycin; D001398:Aztreonam; D010878:Piperacillin