A PROSPECTIVE RANDOMIZED TRIAL OF CEFTAZIDIME VERSUS NETILMICIN PLUS MEZLOCILLIN IN THE EMPIRICAL THERAPY OF PRESUMED SEPSIS IN CIRRHOTIC-PATIENTS

Aminoglycosides are frequently used to treat sepsis in patients with l iver disease. However, it has been suggested that cirrhotic patients a re particularly sensitive to aminoglycoside-induced renal dysfunction. We investigated the efficacy and incidence of renal impairment with n etilmicin plus mezlocillin compared with ceftazidime in 128 cirrhotic patients who required empirical treatment for sepsis. Renal impairment developed in 8 of 63 (13%) patients receiving netilmicin compared wit h 2 of 65 (3%) patients receiving ceftazidime (P < .05); it occurred d espite regular monitoring of trough netilmicin levels. Renal impairmen t was present at the time of death in 1 of 13 (8%) patients treated wi th ceftazidime compared with 5 of 9 (56%) of the netilmicin patients ( P < .05). Mortality rates were similar in the two groups (ceftazidime 20%, aminoglycoside 14%; P = NS). Renal dysfunction is significantly m ore frequent in cirrhotic patients treated with netilmicin but with ca reful attention to dosage and fluid management the clinical effect is likely to be relatively modest.