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Antibiotics in Liver Cirrhosis

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Pharmacotherapy for Liver Cirrhosis and Its Complications

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Abstract

Patients with cirrhosis are susceptible to a wide variety of infections. Sepsis is an established precipitant of acute on chronic liver failure (ACLF). The occurrence of sepsis in cirrhosis is associated with high morbidity and mortality and warrants early recognition and prompt treatment. Antibiotics are widely used in patients with cirrhosis both prophylactically and as a part of treatment to control sepsis. However, since a majority of the antibiotics used are metabolized through the liver, it is important to take note of the altered pharmacodynamics and pharmacokinetics in cirrhosis while prescribing antibiotics. Drugs and medications can cause hepatic injury and exacerbate pre-existing liver disease, leading to decompensations and ACLF. Besides, patients with cirrhosis often have underlying renal dysfunction. This can be further potentiated by the use of nephrotoxic antibiotics. Antibiotics can also cause cytopenias, neurotoxicity, and skin injury. The emergence of drug-resistant bacteria is also a challenge in the setting of cirrhosis. Judicious and rational use of antibiotics, early de-escalation, and implementation of antibiotic stewardship programmes are essential to tackle the problem of drug resistance. Careful selection of antibiotics, knowledge of pharmacological profiles of antibiotics used, awareness of antibiotic-associated toxicities, and strategies to tackle drug resistance are important while prescribing antibiotics in patients with cirrhosis.

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  1. Bharati Vidyapeeth (deemed to be University) Medical College, Pune, Maharashtra, India

    Swati Chouhan

  2. Department of Gastroenterology, S.C.B. Medical College, Cuttack, Odisha, India

    Prajna Anirvan & Shivaram Prasad Singh

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  1. Swati Chouhan
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  2. Prajna Anirvan
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  1. Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China

    Xingshun Qi

  2. Faculty of Liver Disease of Chinese People’s Liberation Army General Hospital, The Fifth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China

    Yongping Yang

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Chouhan, S., Anirvan, P., Singh, S.P. (2022). Antibiotics in Liver Cirrhosis. In: Qi, X., Yang, Y. (eds) Pharmacotherapy for Liver Cirrhosis and Its Complications. Springer, Singapore. https://doi.org/10.1007/978-981-19-2615-0_4

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