The Effects of Oral Administration of Polymyxin B Sulfate and Tinidazol in Patients with Esophageal Varices

Mitsuru Kikuchi, Masatoshi Watanabe¹⁾, Masaru Ogawa¹⁾, Ryuji Nakamura¹⁾, Kazuyoshi Saito¹⁾, Katsuya Inada²⁾, Masao Yoshida²⁾

Critical Care and Emergency Center, ¹⁾The First Department of Surgery and ²⁾Department of Bacteriology, School of Medicine, Iwate Medical University

The recent discovery of a non-endotoxic reactive pathway in the conventional Limulus test has indicated that serum endotoxin (Et), being derived from the intestinal bacterial flora, may become pathogenic (endogenous entotoxemia) under some conditions. Revaluation of postoperative endogenous entotoxemia was done by an endotoxin-specific chromogenic assay (Endospecy, Seikagaku Kogyo, Tokyo, Japan) using 32 patients with esophageal varices and liver disease (cirrhosis; 26, idiopathic portal hypertension: 6). In addition, the effects of oral polymxin-B sulfate (PL-B) and/or tindiazol (TDZ) administration prior to surgery (esophageal transcetion: 27, Hassab's operation: 5) were estimated on the basis of changes in bacterial flora in the rectum after administration and the postoperative serum Et level. Et was increased on the 1st postoperative day (POD) (7.4±5.3 pg/ml) compared with the preoperative period (5.8±4.6 pg/ml). Thereafter, it was decreased on the 3rd and 5th POD. PL-B administration (300 million units/day) reduced the increase in Et level. However, administration of a large quantity of PL-B (600 million units/day) or adding TDZ (1000 mg/day) to PL-B failed to cause a further reduction in the Et level. Based on the change in the bacterial flora of the rectum, an increase in anaerobic bacteria (in PL-B administration) or E. coli (in PL-B+TDZ administration) may be the cause of the failure. No apparent septic manifestion occurred during the postoperative course. Surgical stress on patients with liver impairment caused the serum Et level to increase up to within the normal limit. If additional postoperative morbidity occurred, the endogenous endotoxin level would probably increase enough to be pathogenic. Oral PL-B administration was effective in reducting the Et level.

Key words
Endogenous endotoxemia, polymyxin B sulfate, tinidazol, chemical preparation

Reprint requests
Mitsuru Kikuchi Critical Care and Emergency Center, School of Medicine, Iwate Medical University
19-1 Uchimaru, Morioka, 020 JAPAN

Accepted
November 1, 1993

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