title: Co-administration of phospholipid emulsion with first dose bacteriocidal antibiotic may retard progression of the sepsis response in gram negative septicaemia.
abstract: Endotoxic lipopolysaccharide (LPS) is a major constituent of the outer membrane of the gram-negative bacillus, and its' release a potent pro-inflammatory stimulus. Unchecked the cytokine cascades unleashed by blood borne LPS leads to clinical manifestations of severe sepsis and septic shock. Experimentally exogenous administration of cell-wall specific bacteriocidal drugs are known to precipitate endotoxin release and contribute to development of the sepsis syndrome. Mitigation of the inflammatory septic response with intravenous infusion of phospholipid emulsion has been demonstrated in vivo, with phospholipid credited with binding and neutralizing circulating endotoxin. We therefore propose co-administration of phospholipid emulsion preparations in conjunction with potent cell wall specific antibacterial agents in gram-negative sepsis - hypothesizing that released LPS may be immediately sequestered by phospholipid thereby blunting the severity of the developing septic response.
authors.affiliation: Department of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand. Electronic address: martyn.harvey@waikatodhb.health.nz.
authors.forename: Martyn
authors.initials: M
authors.lastname: Harvey
authors.affiliation: Department of Intensive Care, Tamworth Base Hospital, New South Wales, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Cave
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001407:Bacillus / Q000378:metabolism; D002473:Cell Wall / Q000187:drug effects / Q000378:metabolism; D004655:Emulsions; D004731:Endotoxins / Q000737:chemistry; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D007249:Inflammation; D008070:Lipopolysaccharides / Q000737:chemistry; D008075:Lipoproteins, HDL / Q000008:administration & dosage*; D010743:Phospholipids / Q000008:administration & dosage* / Q000737:chemistry; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D004655:Emulsions; D004731:Endotoxins; D008070:Lipopolysaccharides; D008075:Lipoproteins, HDL; D010743:Phospholipids