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Hypoprothrombinemia in febrile, neutropenic patients with cancer: association with antimicrobial suppression of intestinal microflora.

Abstract
Serial, twice-weekly prothrombin times were determined in 108 febrile, granulocytopenic patients with cancer who were prospectively randomized to receive empiric antimicrobial therapy with moxalactam plus ticarcillin (M/T) or tobramycin plus ticarcillin (T/T). Thirty of 54 patients given M/T and 13 of 54 patients given T/T developed prothrombin times that were greater than or equal to 2 sec beyond control values (P less than .001) after a mean of 6.5 days of antimicrobial therapy. Serious bleeding episodes were more frequent in the group given M/T than in that given T/T (10 and two patients, respectively; P less than or equal to .05). Serial quantitative stool cultures revealed that both Escherichia coli and Bacteroides species were suppressed by greater than or equal to 5 log10 in eight of nine patients given M/T and in three of nine given T/T (P less than .05, Fisher's exact test). A significant reduction of the population of E. coli and Bacteroides fragilis, organisms that are major producers of bacterially synthesized menaquinones, was associated with a high incidence of hypoprothrombinemia. These observations support the hypothesis that menaquinones may play an important physiological role in the maintenance of blood coagulation during episodic dietary deficiency of phylloquinone.
AuthorsJ M Conly, K Ramotar, H Chubb, E J Bow, T J Louie
JournalThe Journal of infectious diseases (J Infect Dis) Vol. 150 Issue 2 Pg. 202-12 (Aug 1984) ISSN: 0022-1899 [Print] United States
PMID6381612 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Bacterial Agents
  • Ticarcillin
  • Moxalactam
  • Tobramycin
Topics
  • Anti-Bacterial Agents (adverse effects, therapeutic use)
  • Bacterial Infections (complications, drug therapy)
  • Bacteroides (growth & development)
  • Drug Therapy, Combination
  • Escherichia coli (growth & development)
  • Feces (microbiology)
  • Hemorrhagic Disorders (etiology)
  • Humans
  • Hypoprothrombinemias (etiology)
  • Intestines (microbiology)
  • Moxalactam (adverse effects)
  • Neoplasms (complications)
  • Neutropenia (complications)
  • Prothrombin Time
  • Ticarcillin (adverse effects)
  • Tobramycin (adverse effects)

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