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Effect of Fluoroquinolone on the Enhanced Nitric Oxide-Induced Peripheral Vasodilation Seen in Cirrhosis
- Jaye P.F. Chin-Dusting, PhD;
- Brindi Rasaratnam, MBBS;
- Garry L.R. Jennings, MD, FRACP; and
- Francis J. Dudley, FRACP
- From Baker Medical Research Institute and Alfred Hospital, Prahran, Australia. Acknowledgments: The authors thank Leonie Johnston for nursing care and Pam Arnold for technical expertise. Grant Support: By a grant from the Alfred Healthcare Trusts and a Baker Medical Research Institute grant from the Australian National Health and Medical Research Council. Requests for Reprints: Jaye P.F. Chin-Dusting, PhD, Alfred and Baker Medical Unit, Baker Medical Research Institute, Commercial Road, Prahran 3181, Victoria, Australia. Current Author Addresses: Drs. Chin-Dusting and Jennings: Alfred and Baker Medical Unit, Baker Medical Research Institute, Commercial Road, Prahran 3181, Victoria, Australia.
Abstract
Background: In patients with cirrhosis, portosystemic shunts allow intestinal bacteria and endotoxin to enter the systemic circulation. Endotoxemia may induce increased synthesis of nitric oxide, thereby contributing to arterial vasodilation.
Objective: To test the hypothesis that the antibiotic norfloxacin blocks the effects of nitric oxide.
Design: Placebo-controlled, double-blind, crossover study.
Setting: Alfred Hospital, Melbourne, Australia.
Patients: 9 patients with alcohol-related cirrhosis and 10 healthy controls.
Intervention: Norfloxacin, 400 mg twice daily, for 4 weeks.
Measurements: Peripheral blood flow was measured by using forearm venous occlusion plethysmography.
Results: Basal forearm blood flow was higher in patients with cirrhosis than in controls (3.69 ± 0.27 mL/100mL per minute and 2.47 ± 0.40 mL/100mL per minute; P = 0.014) but returned toward normal after norfloxacin was given (2.64 ± 0.31 mL/100 mL of tissue per minute in patients with cirrhosis). Responses to NG -monomethyl-L-arginine were greater in patients with cirrhosis but returned to normal after norfloxacin was given.
Conclusion: Bacterial endotoxemia in patients with cirrhosis induces increased synthesis of nitric oxide that can be corrected with norfloxacin.
- Copyright ©2004 by the American College of Physicians
