The Effect of a Bowel Sterilizing Antibiotic on Blood Coagulation Mechanisms

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Abstract
The effect of the inhibition of the normal intestinal flora on the whole and dilute plasma prothrombin time, the recalcification time, the heparin tolerance test, prothrombin consumption tests and the antithrombin tests has been described in 6 subjects. With the exception of changes in the recalcification time of 4 subjects, the other coagulation parameters were not affected. From our own experiments from a review of the literature, evidence was not obtained supporting the impression that antibiotics can adversely affect clotting mechanisms in normal humans, or in those receiving anticoagulant drugs. In all of our subjects Paromomycin was administered orally in the amounts of 2 gm daily in divided doses. No objectionable side effects were noted but overgrowth of stool cultures with fungi was noted in some of our subjects. When staphylococci were present in the stool, there was no tendency for overgrowth of these organisms. The bacterial flora of all subjects returned to normal over a variable period of time when Paromomycin administration was discontinued. A clear relationship of the quantitative and qualitative role of the intestinal organisms, particularly coliform organisms, for the synthesis and absorption of vitamin K in the intestine is not as yet clearly understood. As long as Paromomycin was administered orally, there was a lowering of the total blood cholesterol as has been previously noted with other bowel sterilizing antibiotics. When the administration of Paromomycin was discontinued, the cholesterol levels increased to pretreatment values over a variable period of time. It should be noted that in the fourth subject the cholesterol lowering effect of Paromomycin was transient, and appeared to parallel the curves for aerobes and anerobes rather than that of the coliform organisms.