title: Propensity to release endotoxin after two repeated doses of cefuroxime in an in vitro kinetic model: higher release after the second dose.
abstract: OBJECTIVE
  To study endotoxin release from two strains of Escherichia coli after exposure to two repeated doses of cefuroxime in an in vitro kinetic model.
  
  
  METHODS
  Cefuroxime in concentrations simulating human pharmacokinetics was added to the bacterial solution with a repeated dose after 12 h. In another experiment, tobramycin was given concomitantly with the second dose of cefuroxime. Samples for viable counts and endotoxin analyses were drawn before the addition of antibiotics and at 2 and 4 h after each dose.
  
  
  RESULTS
  The propensity to release endotoxin, expressed as log10 endotoxin release (EU)/log10 killed bacteria, was higher after the second than after the first dose, 0.80+/-0.04 and 0.65+/-0.01, respectively, in the ATCC strain and 0.80+/-0.04 and 0.65+/-0.02, respectively, in the clinical strain (P<0.001). Endotoxin was released earlier after the second dose (P<0.001). Addition of tobramycin at the second dose reduced the endotoxin release in comparison with that of cefuroxime alone (P<0.001).
  
  
  CONCLUSIONS
  The propensity to liberate endotoxin is higher after the second dose of cefuroxime than after the first, resulting in a higher release of endotoxin than expected from bacterial count. The release after the second dose can be reduced by the addition of tobramycin.
authors.affiliation: Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. gunilla.hjerdt.goscinski@akademiska.se
authors.forename: G
authors.initials: G
authors.lastname: Goscinski
authors.forename: E
authors.initials: E
authors.lastname: Tano
authors.forename: E
authors.initials: E
authors.lastname: Löwdin
authors.forename: J
authors.initials: J
authors.lastname: Sjölin
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002444:Cefuroxime / Q000494:pharmacology*; D015169:Colony Count, Microbial; D003470:Culture Media; D004305:Dose-Response Relationship, Drug; D004731:Endotoxins / Q000378:metabolism*; D004926:Escherichia coli / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007700:Kinetics; D008826:Microbial Sensitivity Tests; D008855:Microscopy, Electron, Scanning; D014031:Tobramycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media; D004731:Endotoxins; D002444:Cefuroxime; D014031:Tobramycin