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Ceftazidime- and imipenem-induced endotoxin release during treatment of gram-negative infections
B Byl1, P Clevenbergh, A Kentos
1Infectious Diseases Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. baudouin.byl@ulb.ac.be
Abstract:
To determine whether ceftazidime and imipenem, which target two different penicillin-binding proteins, result in different amounts of endotoxin and cytokine release in patients with gram-negative infection, plasma endotoxin, interleukin-6, and tumor necrosis factor alpha were measured during the first 24 h of antibiotic therapy in 27 patients with gram-negative infection who had been randomized to receive either ceftazidime 2 g t.i.d. (n=12) or imipenem/cilastatin 1 g t.i.d. (n=15). The source of infection was the digestive tract (n=13), the urinary tract (n=5), the respiratory tract (n=2), soft tissue (n=2), i.v. line (n=2), or other (n=3). After the first antibiotic injection, a significant increase in the median concentration of plasma interleukin-6 and plasma tumor necrosis factor alpha was noted, without significant differences related to the antibiotic administered. Antibiotic-induced endotoxemia was detectable in nine patients (including 7 with bacteremia). In conclusion, ceftazidime and imipenem had similar effects on endotoxin and cytokine release during the treatment of gram-negative infections.
Insights
Ceftazidime and imipenem showed similar effects on endotoxin and cytokine release in patients with gram-negative infections. This study measured plasma endotoxin, interleukin-6, and tumor necrosis factor alpha during antibiotic therapy.
Area of Science:
- Infectious Diseases
- Pharmacology
- Immunology
Background:
- Gram-negative infections pose significant health risks.
- Antibiotic choice can influence patient outcomes.
- Understanding endotoxin and cytokine release is crucial for managing sepsis.
Purpose of the Study:
- To compare the effects of ceftazidime and imipenem on endotoxin and cytokine release.
- To investigate differences in inflammatory marker release between two distinct antibiotic classes.
- To assess the impact of antibiotic therapy on endotoxemia in gram-negative infections.
Main Methods:
- Randomized controlled trial involving 27 patients with gram-negative infections.
- Measurement of plasma endotoxin, interleukin-6, and tumor necrosis factor alpha.
- Comparison of ceftazidime and imipenem/cilastatin treatment groups over 24 hours.
Main Results:
- A significant increase in interleukin-6 and tumor necrosis factor alpha was observed after the first antibiotic dose.
- No significant differences in cytokine release were found between ceftazidime and imipenem groups.
- Antibiotic-induced endotoxemia was detected in some patients, particularly those with bacteremia.
Conclusions:
- Ceftazidime and imipenem exhibit comparable effects on endotoxin and cytokine release.
- The choice between these antibiotics does not appear to significantly alter the inflammatory response in the initial phase of treatment.
- Further research may explore long-term outcomes and specific patient subgroups.