Effect of antibiotics therapy on serum vitamin K level

Vitamin K deficiency has occurred in patients receiving broad-spectrum antibiotics. The mechanism of hypoprothrombinemia in patients treated with antibiotics is still unknown, although it is suggested to result from impared synthesis of vitamin K by suppression of intestinal bacteria or interference...

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Published inBlood & Vessel Vol. 18; no. 3; pp. 274 - 277
Main Authors KAYASHIMA, Narumi, SHIRAHATA, Akira, NAKAMURA, Toshio, KOMATSU, Keiko, ASAKURA, Akio
Format Journal Article
LanguageEnglish
Published The Japanese Society on Thrombosis and Hemostasis 1987
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ISSN0386-9717
1884-2372
1884-2372
DOI10.2491/jjsth1970.18.274

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Abstract Vitamin K deficiency has occurred in patients receiving broad-spectrum antibiotics. The mechanism of hypoprothrombinemia in patients treated with antibiotics is still unknown, although it is suggested to result from impared synthesis of vitamin K by suppression of intestinal bacteria or interference of vitamin K utilization in the liver. We studied the serum vitamin K concentration in patients receiving broad-spectrum antibiotics for 7 days or more, in order to clarify the mechanism of antibiotics induced vitamin K deficiency. The coagulation abnormalities compatible with vitamin K deficiency were seen in 7 patients in whom predisposing factors for vitamin K deficiency were male, poor dietary intake and therapy of antibiotics with N-methyl-tetrazol thiol. In these patients, serum vitamin K1 and vitamin K2 (menaquinone-7) levels was extremly lower when compared to normal adult levels. On the other hand, vitamin K1 levels in 5 of 6 patients with normal coagulation status moderately decreased to the levels under minus 1 standard deviation of normal adults, and serum vitamin K2 in 3 patients with normal coagulation status and very poor dietary intake was not detected. These results may suggest that vitamin K deficiency in patients receiving antibiotics is induced by poor oral intake, altered absorption of vitamin K in the intestine and/or impaired synthesis of vitamin K by suppression of intestinal bacteria.
AbstractList Vitamin K deficiency has occurred in patients receiving broad-spectrum antibiotics. The mechanism of hypoprothrombinemia in patients treated with antibiotics is still unknown, although it is suggested to result from impared synthesis of vitamin K by suppression of intestinal bacteria or interference of vitamin K utilization in the liver. We studied the serum vitamin K concentration in patients receiving broad-spectrum antibiotics for 7 days or more, in order to clarify the mechanism of antibiotics induced vitamin K deficiency. The coagulation abnormalities compatible with vitamin K deficiency were seen in 7 patients in whom predisposing factors for vitamin K deficiency were male, poor dietary intake and therapy of antibiotics with N-methyl-tetrazol thiol. In these patients, serum vitamin K1 and vitamin K2 (menaquinone-7) levels was extremly lower when compared to normal adult levels. On the other hand, vitamin K1 levels in 5 of 6 patients with normal coagulation status moderately decreased to the levels under minus 1 standard deviation of normal adults, and serum vitamin K2 in 3 patients with normal coagulation status and very poor dietary intake was not detected. These results may suggest that vitamin K deficiency in patients receiving antibiotics is induced by poor oral intake, altered absorption of vitamin K in the intestine and/or impaired synthesis of vitamin K by suppression of intestinal bacteria.
Author KOMATSU, Keiko
ASAKURA, Akio
NAKAMURA, Toshio
KAYASHIMA, Narumi
SHIRAHATA, Akira
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References 2) Hooper, C. A., Haney, B. B. and Stone, A. H.: Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet, 1; 39-40, 1980.
7) Uotila, L. and Suttie, J. W.: Inhibition of vitamin K-dependent carboxylase in vitro by cefamandole and its structural analogs. J. Infect. Dis., 148; 571-578, 1983.
10) Bechtolod, H., Lorenz, J., Weilemann, L. S., Meinertz, T., Trenk, D., Andrassy, K. and Jähnchen, E.: Possible coumarin-like mechanism of action for cephalosporins. Klin. Wochenschr., 62; 885-886, 1984.
11) 白幡聡, 萱嶌成美: ビタミンKの高感度測定法. Medical Way, 2; 71-74, 1985.
5) Kammer, R. B.: Moxalactam: clinical summary of efficacy and safety. Rev. Infect. Dis., 4 (Suppl.): 712-719, 1982.
8) Lipsky, J. J.: N-methyl-thio-tetrazol inhibition of the gamma carboxylation of gultamic acid: possible mechanism for antibiotic-associated hypoprothrombinaemia. Lancet, 2; 192-193, 1983.
3) Rymer, W. and Greenlaw, C. W.: Hypoprothrombinemia associated with cefamandole. Drug Intelligence and Clinical Pharmacy, 14; 780-783, 1980.
4) Reddy, J. and Bailey, R. R.: Vitamin K deficiency developing in patient with renal failure treated with cephalosporin antibiotics. N. Z. Med. J., 92; 378-379, 1980.
12) 白幡聡, 中村外士雄: ヒト生体試料中の vitamin K1 (phylloquinone) および vitamin K2 (menaquinone) 同族体の個別測定. 血液と脈管, 16; 395-401, 1985.
9) Neu, H. C.: Adverse effects of new cephalosporins. Ann. Intern. Med., 93; 415-416, 1983.
6) 岩田敏: 抗生剤投与中の腸内細菌叢及び血液凝固系の変動に関する検討. 感染症学会雑誌, 58; 903-919, 1984.
1) Pineo, G. F., Gallus, A. S. and Hirsh, J.: Unexpected vitamin K deficiency in hospitalized patients. Canad. Med. Assoc. J., 109; 880-883, 1973.
References_xml – reference: 6) 岩田敏: 抗生剤投与中の腸内細菌叢及び血液凝固系の変動に関する検討. 感染症学会雑誌, 58; 903-919, 1984.
– reference: 8) Lipsky, J. J.: N-methyl-thio-tetrazol inhibition of the gamma carboxylation of gultamic acid: possible mechanism for antibiotic-associated hypoprothrombinaemia. Lancet, 2; 192-193, 1983.
– reference: 3) Rymer, W. and Greenlaw, C. W.: Hypoprothrombinemia associated with cefamandole. Drug Intelligence and Clinical Pharmacy, 14; 780-783, 1980.
– reference: 12) 白幡聡, 中村外士雄: ヒト生体試料中の vitamin K1 (phylloquinone) および vitamin K2 (menaquinone) 同族体の個別測定. 血液と脈管, 16; 395-401, 1985.
– reference: 2) Hooper, C. A., Haney, B. B. and Stone, A. H.: Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet, 1; 39-40, 1980.
– reference: 7) Uotila, L. and Suttie, J. W.: Inhibition of vitamin K-dependent carboxylase in vitro by cefamandole and its structural analogs. J. Infect. Dis., 148; 571-578, 1983.
– reference: 9) Neu, H. C.: Adverse effects of new cephalosporins. Ann. Intern. Med., 93; 415-416, 1983.
– reference: 11) 白幡聡, 萱嶌成美: ビタミンKの高感度測定法. Medical Way, 2; 71-74, 1985.
– reference: 1) Pineo, G. F., Gallus, A. S. and Hirsh, J.: Unexpected vitamin K deficiency in hospitalized patients. Canad. Med. Assoc. J., 109; 880-883, 1973.
– reference: 10) Bechtolod, H., Lorenz, J., Weilemann, L. S., Meinertz, T., Trenk, D., Andrassy, K. and Jähnchen, E.: Possible coumarin-like mechanism of action for cephalosporins. Klin. Wochenschr., 62; 885-886, 1984.
– reference: 4) Reddy, J. and Bailey, R. R.: Vitamin K deficiency developing in patient with renal failure treated with cephalosporin antibiotics. N. Z. Med. J., 92; 378-379, 1980.
– reference: 5) Kammer, R. B.: Moxalactam: clinical summary of efficacy and safety. Rev. Infect. Dis., 4 (Suppl.): 712-719, 1982.
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Snippet Vitamin K deficiency has occurred in patients receiving broad-spectrum antibiotics. The mechanism of hypoprothrombinemia in patients treated with antibiotics...
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SubjectTerms antibiotics
menaquinone
N-metyl-tetrazol tiol
phylloquinone
vitamin K deficiency
Title Effect of antibiotics therapy on serum vitamin K level
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