title: Immunomodulatory clarithromycin treatment of experimental sepsis and acute pyelonephritis caused by multidrug-resistant Pseudomonas aeruginosa.
abstract: Clarithromycin was administered intravenously to 55 rabbits to evaluate its effect on experimental sepsis caused by multidrug-resistant Pseudomonas aeruginosa. Acute pyelonephritis was induced after ligation of the right ureter and injection of 10(8) CFU of the test isolate per kg of body weight into the renal pelvis. The animals were divided into six groups: group A, controls; group B, rabbits that received one intravenous dose of 80 mg of clarithromycin per kg concomitantly with bacterial challenge; group C, rabbits that received two doses of clarithromycin, the second one of which was given 2 h after the first one; group D, rabbits that received 15 mg of amikacin per kg; group E, rabbits that received one dose of clarithromycin and amikacin; and group F, rabbits that received two doses of clarithromycin and amikacin. Serum endotoxin levels were estimated by the QCL-1000 Limulus amoebocyte lysate assay, tumor necrosis factor alpha (TNF-alpha) levels were measured by a bioassay, and malondialdehyde (MDA) levels were measured by the thiobarbiturate assay. Viable bacterial counts in various tissue samples were also assessed. The mean survival times of the animals in groups A, B, C, D, E, and F were 4.50, 7.69, 4.07, 4.55, 11.55, and 11.60 days, respectively (P = 0.033 for group D versus group F, P = 0.006 for group D versus group E, P = not significant for group B versus group E, P = 0.042 for group C versus group F). Serum endotoxin levels were similar between groups at all sampling times; TNF-alpha and MDA levels in groups B, C, E, and F decreased significantly over follow-up. The numbers of viable bacterial cells in the infected kidney were similar among the groups; those in the liver, spleen, lungs, and mesenteral lymph nodes were significantly decreased in groups B, E, and F compared to those in groups A and D. It is concluded that a prolongation of survival in animals with experimental sepsis caused by multidrug-resistant P. aeruginosa was achieved after coadministration of clarithromycin and amikacin and that the increased survival was probably attributable to the immunomodulatory properties of clarithromycin.
authors.affiliation: 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece. giamarel@internet.gr
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: Theodoros
authors.initials: T
authors.lastname: Adamis
authors.forename: George
authors.initials: G
authors.lastname: Laoutaris
authors.forename: Lambros
authors.initials: L
authors.lastname: Sabracos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Koussoulas
authors.forename: Maria
authors.initials: M
authors.lastname: Mouktaroudi
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Panayotis E
authors.initials: PE
authors.lastname: Karayannacos
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017291:Clarithromycin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D024901:Drug Resistance, Multiple, Bacterial; D007109:Immunity / Q000187:drug effects; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D011817:Rabbits; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000276:Adjuvants, Immunologic; D000900:Anti-Bacterial Agents; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D008315:Malondialdehyde; D017291:Clarithromycin