Ceftazidime- and imipenem-induced endotoxin release during treatment of gram-negative infections.
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.
Byl
B
B
Infectious Diseases Clinic, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. baudouin.byl@ulb.ac.be
Clevenbergh
P
P
Kentos
A
A
Jacobs
F
F
Marchant
A
A
Vincent
J L
JL
Thys
J P
JP
D016470:Bacteremia / Q000097:blood / Q000188:drug therapy; D002442:Ceftazidime / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004731:Endotoxins / Q000097:blood*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000188:drug therapy; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage*; D007275:Injections, Intravenous; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D011336:Probability; D012016:Reference Values; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D004731:Endotoxins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D015378:Imipenem; D002442:Ceftazidime