Medical Emergencies · single question
A patient with liver cirrhosis — which antibiotic is recommended?
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Correct answer: C. Penicillin VK
- A. Metronidazole is extensively hepatically metabolized — it requires DOSE REDUCTION in cirrhosis and should be used with caution.
- B. Clindamycin is primarily hepatically metabolized and may accumulate in cirrhosis — it should be used with caution.
- C. PENICILLIN VK is the PREFERRED antibiotic in patients with liver cirrhosis because it is primarily excreted RENALLY (not hepatically metabolized). Cirrhotic patients have impaired hepatic metabolism, making hepatically-metabolized drugs potentially toxic. Penicillin VK's renal excretion makes it safe to use at standard doses in most cirrhotic patients.
- D. The clavulanate component of amoxicillin-clavulanate is associated with hepatotoxicity and should be avoided or used with extreme caution in cirrhotic patients.
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