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Journal of Antimicrobial Chemotherapy (1992) 30, 215-220
© 1992 The British Society for Antimicrobial Chemotherapy

research-article

An open, comparative triai of aztreonam with vancomycin and gentamicin with piperacillin in patients with fulminant hepatic failure

N. Rolandoa, J. J. Wadeb, E. Fagana, J. Philpott-Howardb, M. W. Casewellb and Roger Williamsa

aInstitute of Liver Studies Bessemer Road, London SE5 8RX, UK bDepartment of Medical Microbiology, King's College School of Medicine and Dentistry Bessemer Road, London SE5 8RX, UK

Received 2 September 1991; returned 13 April 1992; accepted 13 April 1992

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.


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