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Norfloxacin Therapy for Hepatopulmonary Syndrome: A Pilot Randomized Controlled Trial.

Author(s): Gupta S, Faughnan ME, Lilly L, Hutchison S, Fowler R, Bayoumi AM

Affiliation(s): Department of Medicine, University of Toronto; Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario.

Publication date & source: 2010-08-31, Clin Gastroenterol Hepatol., [Epub ahead of print]

BACKGROUND AND AIMS: The hepatopulmonary syndrome occurs in up to one third of patients with cirrhosis. Animal models of this disease suggest that endotoxemia may cause nitric oxide-mediated vascular dilatation which can be inhibited by the antibiotic norfloxacin. We sought to test this hypothesis in humans. METHODS: We conducted a pilot randomized, controlled crossover trial of norfloxacin 400 mg twice daily for four weeks with a four-week washout period in order to assess the feasibility of a larger trial. The primary clinical endpoint was change in alveolar-arterial oxygen gradient (AaDO(2)). RESULTS: Recruitment was challenging and change in AaDO(2) was highly variable. We recruited 9 adults (1/9 female, age 60 +/- 9 years, AaDO(2) 50 +/- 22 mmHg). AaDO(2) decreased by 0.8 +/- 4.8 and 3.4 +/- 12.4 mmHg while on norfloxacin and placebo, respectively (p=0.59). CONCLUSIONS: Recruitment difficulties and variability of the primary outcome measure suggest the need for a multi-center clinical research network for future therapeutic trials in this disease. There was no major effect of norfloxacin on gas-exchange in patients with hepatopulmonary syndrome. Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Page last updated: 2010-10-05

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