Antibiotic Therapy in the Management of Hepatic Coma

Hepatic coma is a metabolic disturbance occurring in some patients with liver disease which manifests itself as a "disorder of consciousness." The clinical features of the syndrome have been defined by Adams and Foley,¹providing criteria for diagnosis and a background for the investigation of its pathogenesis. The relationship between this disorder and toxic nitrogenous substances is generally recognized.²These toxic substances, including ammonia, are believed to be a product of bacterial enzymatic action within the intestine.³Antibacterial agents effective against intestinal organisms have been reported to improve prognosis in hepatic coma.^4,5,7Assessment of results is complicated by the simultaneous utilization of a number of therapeutic measures and by the varied prognosis of the syndrome. Studies such as that reported by Fisher and Faloon⁶of patients with episodic stupor, whether spontaneous or following portacaval anastomosis, allow more controlled observations related to isolated therapeutic efforts. We with