Therapeutic Effect of Vancomycin Hydrochloride, a Nonabsorbable Antibiotics, on Intractable (Lactulose Resistant) Chronic Hepatic Encephalopathy in Cirrhotic Patients

Abstract

Vancomycin hydrochloride, a nonabsorbable antibiotics, which is effective against anaerobic but ineffective against aerobic gram negative rods, was administered to five consecutive cirrhotics with intractable portal-systemic encephalopathy (PSE) who were resistant to oral lactulose administration, and changes in clinical features, blood ammonia levels, electroencephalograms, and in faecal bacterial flora were examined. Vancomycin was also administered to one cirrhotic case in which administration of lactulose caused the severe diarrhoe during the use of the drug. Clinical features of encephalopathy disappeared in all cases, and electroencephalograms showed marked improvements. Faecal bacterial investigation showed that the anaerobic gram-negative rods (chiefly Bacteroides spp) were 10^8-9 counts per gram of stool on administration of lactulose, but remarkably decreased to 10^3-6 counts after administration of vancomycin. It is concluded that vancomycin is effective to the intractable PSE because of the marked decrease in anaerobic gram-negative rods.