Skip to main content
Gut logoLink to Gut
. 1982 Jan;23(1):1–7. doi: 10.1136/gut.23.1.1

Treatment of hepatic encephalopathy with metronidazole.

M H Morgan, A E Read, D C Speller
PMCID: PMC1419597  PMID: 7035298

Abstract

Neomycin, an antibiotic which is primarily active against the aerobic gut flora and hence reduces the endogenous production of ammonia, is a well-recognised form of treatment for acute or acute on chronic hepatic encephalopathy. This study suggests that metronidazole may be a useful alternative or even adjunctive treatment for such patients. Theoretical and practical justifications for the use of this drug are presented. The results of a week's prescription of each drug have been assessed by changes in clinical and biochemical criteria, including electroencephalograms and arterial ammonia sample. In the treatment of a series of 11 mildly or moderately, and seven severely affected, patients with histologically confirmed cirrhosis, metronidazole is shown to be as effective as neomycin.

Full text

PDF
1

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arabi Y., Dimock F., Burdon D. W., Alexander-Williams J., Keighley M. R. Influence of neomycin and metronidazole on colonic microflora of volunteers. J Antimicrob Chemother. 1979 Sep;5(5):531–537. doi: 10.1093/jac/5.5.531. [DOI] [PubMed] [Google Scholar]
  2. Barry R. E., Chow A. W., Billesdon J. Role of intestinal microflora in colonic pseudoobstruction complicating jejunoileal bypass. Gut. 1977 May;18(5):356–359. doi: 10.1136/gut.18.5.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berk D. P., Chalmers T. Deafness complicating antibiotic therapy of hepatic encephalopathy. Ann Intern Med. 1970 Sep;73(3):393–396. doi: 10.7326/0003-4819-73-3-393. [DOI] [PubMed] [Google Scholar]
  4. Brown C. L., Hill M. J., Richards P. Bacterial ureases in uraemic men. Lancet. 1971 Aug 21;2(7721):406–407. doi: 10.1016/s0140-6736(71)90119-x. [DOI] [PubMed] [Google Scholar]
  5. CONN H. O. Asterixis in non-hepatic disorders. Am J Med. 1960 Oct;29:647–661. doi: 10.1016/0002-9343(60)90098-x. [DOI] [PubMed] [Google Scholar]
  6. Conn H. O., Leevy C. M., Vlahcevic Z. R., Rodgers J. B., Maddrey W. C., Seeff L., Levy L. L. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial. Gastroenterology. 1977 Apr;72(4 Pt 1):573–583. [PubMed] [Google Scholar]
  7. DAVIES A. H., MCFADZEAN J. A., SQUIRES S. TREATMENT OF VINCENT'S STOMATITIS WITH METRONIDAZOLE. Br Med J. 1964 May 2;1(5391):1149–1150. doi: 10.1136/bmj.1.5391.1149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. FALOON W. W., FISHER C. J. Clinical experience with the use of neomycin in hepatic coma. AMA Arch Intern Med. 1959 Jan;103(1):43–53. doi: 10.1001/archinte.1959.00270010049007. [DOI] [PubMed] [Google Scholar]
  9. Fessel J. M., Conn H. O. Lactulose in the treatment of acute hepatic encephalopathy. Am J Med Sci. 1973 Aug;266(2):103–110. doi: 10.1097/00000441-197308000-00003. [DOI] [PubMed] [Google Scholar]
  10. Ingham H. R., Hall C. J., Sisson P. R., Tharagonnet D., Selkon J. B. Inactivation of metronidazole by aerobic organisms. J Antimicrob Chemother. 1979 Nov;5(6):734–735. doi: 10.1093/jac/5.6.734. [DOI] [PubMed] [Google Scholar]
  11. JACOBSON E. D., PRIOR J. T., FALOON W. W. Malabsorptive syndrome induced by neomyclin: morphologic alterations in the jejunal mucosa. J Lab Clin Med. 1960 Aug;56:245–250. [PubMed] [Google Scholar]
  12. Nastro L. J., Finegold S. M. Bactericidal activity of five antimicrobial agents against Bacteroides fragilis. J Infect Dis. 1972 Jul;126(1):104–107. doi: 10.1093/infdis/126.1.104. [DOI] [PubMed] [Google Scholar]
  13. Onderdonk A. B., Louie T. J., Tally F. P., Bartlett J. G. Activity of metronidazole against Escherichia coli in experimental intra-abdominal sepsis. J Antimicrob Chemother. 1979 Mar;5(2):201–210. doi: 10.1093/jac/5.2.201. [DOI] [PubMed] [Google Scholar]
  14. PARSONS-SMITH B. G., SUMMERSKILL W. H., DAWSON A. M., SHERLOCK S. The electroencephalograph in liver disease. Lancet. 1957 Nov 2;273(7001):867–871. doi: 10.1016/s0140-6736(57)90005-3. [DOI] [PubMed] [Google Scholar]
  15. PHEAR E. A., RUEBNER B., SHERLOCK S., SUMMERSKILL W. H. Methionine toxicity in liver disease and its prevention by chlortetracycline. Clin Sci. 1956 Feb;15(1):93–117. [PubMed] [Google Scholar]
  16. PHILLIPS G. B., SCHWARTZ R., GABUZDA G. J., Jr, DAVIDSON C. S. The syndrome of impending hepatic coma in patients with cirrhosis of the liver given certain nitrogenous substances. N Engl J Med. 1952 Aug 14;247(7):239–246. doi: 10.1056/NEJM195208142470703. [DOI] [PubMed] [Google Scholar]
  17. Read A. E., Laidlaw J., McCarthy C. F. Effects of chlorpromazine in patients with hepatic disease. Br Med J. 1969 Aug 30;3(5669):497–499. doi: 10.1136/bmj.3.5669.497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Read A. E., McCarthy C. F., Ajdukiewicz A. B., Brown G. J. Encephalopathy after portacaval anastomosis. Lancet. 1968 Nov 9;2(7576):999–1001. doi: 10.1016/s0140-6736(68)91295-6. [DOI] [PubMed] [Google Scholar]
  19. SELIGSON D., HIRAHARA K. The measurement of ammonia in whole blood, erythrocytes, and plasma. J Lab Clin Med. 1957 Jun;49(6):962–974. [PubMed] [Google Scholar]
  20. Tally F. P., Sutter V. L., Finegold S. M. Metronidazole versus anaerobes. In vitro data and initial clinical observations. Calif Med. 1972 Dec;117(6):22–26. [PMC free article] [PubMed] [Google Scholar]
  21. Thomas H. C., Potter B. J., Sherlock S. Is primary biliary cirrhosis an immune complex disease? Lancet. 1977 Dec 17;2(8051):1261–1263. doi: 10.1016/s0140-6736(77)92666-6. [DOI] [PubMed] [Google Scholar]
  22. Vince A. J., Burridge S. M. Ammonia production by intestinal bacteria: the effects of lactose, lactulose and glucose. J Med Microbiol. 1980 May;13(2):177–191. doi: 10.1099/00222615-13-2-177. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES