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Hypoprothrombinemia in Febrile, Neutropenic Patients with Cancer: Association with Antimicrobial Suppression of Intestinal Microflora

J. M. Conly, K. Ramotar, H. Chubb, E. J. Bow and T. J. Louie
The Journal of Infectious Diseases
Vol. 150, No. 2 (Aug., 1984), pp. 202-212
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30131519
Page Count: 11
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Hypoprothrombinemia in Febrile, Neutropenic Patients with Cancer: Association with Antimicrobial Suppression of Intestinal Microflora
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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 $\geq 2 sec$ beyond control values (P < .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; $P \leq .05$). Serial quantitative stool cultures revealed that both Escherichia coli and Bacteroides species were suppressed by $\geq 5 log_{10}$ in eight of nine patients given M/T and in three of nine given T/T (P < .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.

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