safe antibiotics

[rexx73]

hello everybody,

can somebody tell me what antibiotics without penicillin are safe for cirrhotics.
as iam allergic to penicillin it has to be one without it.
thanks
Marc

[ppmguy]

                i developed an abcess under my arm.  it was very inflamed and painful.   the tx doc ordered 100 mg of Doxycycline for 7 days.  she had me take a LFT + ast,  one week later.  my enzymes were in the 20s thru tx.  my alt flared to 93.  one month later alt was 23.  i am F3-4 and the shorter duration was still effective.         barry

[Dee1956]

I apologize, I did not see that Rex has cirrhosis, it says F3 on his status.  I thought he was looking for antibiotics that are safe for people with liver damage.  I have cirrhosis, my doctor just gave me a z pack.  I know Rex is very anxious and was trying to help him.

[HectorSF]

It is best to consult with a hepatologist. This is especially true for cirrhotics taking medications to manage their cirrhosis as drug to drug interactions can be dangerous.

All transplant centers have pharmacists that specialize in drug treatment for cirrhotics.

All patients should be treated on an individual basis due to their own unique factors.

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Antibiotic Dosing in Cirrhosis

"Liver is an important site of removal of blood bone bacteria. Hepatic destruction of bacteria and reticular endothelial system-related phagocytosis are impaired in patients with cirrhosis. In cirrhotic patients serum bactericidal opsonic activity and neutrophil function are defective. This leads to 5 to 7 fold increase in bacteremia in these patients requiring antibiotics for therapeutic or prophylactic purpose. Extensive literature search was done to identify the antibiotics that need dosage alteration in patients with liver cirrhosis. Macrolide antibiotics like erythromycin, azithromycin, chloramphenicol, lincomycine, and clindamycin which are excreted and detoxified by liver should be used with cautions in these patients. Tetracycline, Isoniazid and Rifampin have prolonged half life in patients with liver cirrhosis. Metronidazole ketocanozole, miconazole, fluconazole, itraconazole, and nitrofurantoin pyrazinamide should be used with caution. Beta-lactum antibiotics can cause leucopenia, while amino glycosides can increase susceptibility to renal failure. Vancomycin can cause increased toxicity in patients with liver failure. Antibiotics which can produce hepatitis or cholestasis should be avoided or used with caution. Tuberculosis was more common in alcoholic and Child class C cirrhosis (Table 1). Antituberculosis therapy (ATT) is associated with hepatotoxicity in 10%. Hepatotoxicity requires withdrawal, modification, and sequential reintroduction to achieve cure of tuberculosis. Using such hepatotoxic drugs in presence of cirrhosis or advanced liver disease is a challenge. Cirrhotic patients with tuberculosis have significantly lower completion of Rifamipicin + Isoniazid based ATT, higher hepatotoxicity, and higher mortality. Recommended ATT in Child class A cirrhosis is the same as a noncirrhotic population but strict followup is required. Pyrazinamide may be avoided. In Child class B Pyrazinamide should be avoided, Isoniazid with rifamipicin may be avoided. Isoniazid or rifamipicin with ethambutol and quinolone can be used for 12 to 18 months. In Child Class C ethambutol, quinolone, and one second line agent may be used for 12 to 18 month."

Antibiotics to be avoided in liver disease.

Chloramphenicol—higher risk of bone marrow suppression (markedly increased half life)
Erythromycin estolate: causes cholestasis
Tetracycline—dose related hepatotoxicity
Antituberculous therapy in combinations, pyrazinamide
Griseofulvin—contraindicated
Nalidixic acid
Nitrofurantoin prolonged use

Good luck!
Hector

[Dee1956]

I understand I took Biaxin once and horrilbe pain in the upper right, do not know if it was gall bladder or what but within an hour of taking the pain would start.  I had the medicine changed.  This was before I knew I had hep C
Later...I took it again after tx and no problem so could be coincidence.
One I would never take is in the leviquin family or class of quinolones
I have received an alert that is can cause problems with tendons.
I had one rip in my foot while just walking.
Good luck to you REx

[rexx73]

Hi dee,
thanks for your answer.in my live i had just 2 time antibiotics,2 time with penicillin.the second time I became a rash and had problems to breath.
since then I think iam allergic to penicillin,but its possible that these symptoms I had were related to the infection self and not from penicillin.
so iam not sure iam allergic or not.

Marc

[Dee1956]

As you will see when you click on it, I asked the same question in the cirrhosis forum, Randy gave me a nice list.
I also did a search and Granma said Cefzil.  Many people have asked same, if you need more information you can search, I hope this helps

http://www.medhelp.org/posts/Cirrhosis-of-the-Liver/Antibiotics/show/1898241

[Dee1956]

Hi Rexx, well gosh, penicillin is the safest.  I looked it up a long time ago when I had to take antibiotics.  Saying that my doctor just gave me the Zpack with is arithromycin (sp)
I will go look to see what the best one is after penicillin.  I seem to remember that there were 3 levels of antibiotics, penicillin being the safest