Patients with acute liver failure are particularly susceptible to bacterial and fungal infections. In a prospective study of 50 patients, Rolando et al. found that 90% developed bacterial, and 32% fungal, infection. This usually arose within 3 days of admission, and the usual clinical signs of infection were often absent.
Studies indicate that prophylactic antimicrobial treatments are useful in the prevention of infection in this context. Oral regimens, aimed at eradicating enterobacteria from the intestinal flora, and including an anti-mycotic agent such as nystatin, may be the most effective.
Liver transplantation is less likely to be feasible if antimicrobial therapy is delayed until the onset of clinical evidence of infection.
The choice of agents should be guided by the incidence, type and aetiology of infections in a given centre.
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