Effect of fluoroquinolone on the enhanced nitric oxide-induced peripheral vasodilation seen in cirrhosis.
BACKGROUND
In patients with cirrhosis, portosystemic shunts allow intestinal bacteria and endotoxin to enter the systemic circulation. Endotoxemia may induce increased synthesis of nitric oxide, thereby contributing to arterial vasodilation.


OBJECTIVE
To test the hypothesis that the antibiotic norfloxacin blocks the effects of nitric oxide.


METHODS
Placebo-controlled, double-blind, crossover study.


METHODS
Alfred Hospital, Melbourne, Australia.


METHODS
9 patients with alcohol-related cirrhosis and 10 healthy controls.


METHODS
Norfloxacin, 400 mg twice daily, for 4 weeks.


METHODS
Peripheral blood flow was measured by using forearm venous occlusion plethysmography.


RESULTS
Basal forearm blood flow was higher in patients with cirrhosis than in controls (3.69 +/- 0.27 mL/100 mL per minute and 2.47 +/- 0.40 mL/100 mL per minute; P = 0.014) but returned toward normal after norfloxacin was given (2.64 +/- 0.31 mL/100 mL of tissue per minute in patients with cirrhosis). Responses to NG-monomethyl-L-arginine were greater in patients with cirrhosis but returned to normal after norfloxacin was given.


CONCLUSIONS
Bacterial endotoxemia in patients with cirrhosis induces increased synthesis of nitric oxide that can be corrected with norfloxacin.
Chin-Dusting
J P
JP
Alfred and Baker Medical Unit, Baker Medical Research Institute, Victoria, Australia.
Rasaratnam
B
B
Jennings
G L
GL
Dudley
F J
FJ
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D019446:Endotoxemia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000382:microbiology*; D008875:Middle Aged; D009569:Nitric Oxide / Q000096:biosynthesis* / Q000502:physiology; D009643:Norfloxacin / Q000627:therapeutic use*; D012039:Regional Blood Flow / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects*
D000890:Anti-Infective Agents; D009569:Nitric Oxide; D009643:Norfloxacin