Lack of effect of enteral antibiotics on the post-burn hypermetabolic response

Burn patients who survive the initial 24 h following major burn injury commonly develop a marked hypermetabolism. One of the possible mechanisms of this increased metabolic rate is gut translocation of bacteria and endotoxin following burn injury. We attempted to decrease the hypermetabolism by administering various antibiotic and endotoxin binding agents enterally in a burned guinea-pig model. Adult guinea-pigs were given polymyxin B, trimethoprim and sulphamethoxazole, or neomycin and clindamycin, or Kaopectate, sodium deoxycholate, neomycin, clindamycin and polymyxin B. A control group received no drugs. The drugs were administered through a gastrostomy tube beginning the day before burn injury and continuing for 14 days. There was no significant decrease in the resting metabolic rate in any of the treated groups compared to controls. Neither enteral antibiotics nor endotoxin binding agents were able to induce a significant reduction in the post-burn hypermetabolic response in this model.