Critical Care

, 8:141 | Cite as

Anti-inflammatory effects of the antibiotics ceftazidime and tobramycin in porcine endotoxin shock: are they really anti-inflammatory? Authors' response

  • Gunilla Goscinski
  • Miklos Lipcsey
  • Mats Eriksson
  • Anders Larsson
  • Eva Tano
  • Jan Sjölin
Letter
  • 2.3k Downloads

Keywords

Septic Shock Severe Sepsis Organ Dysfunction Ceftazidime Tobramycin 

Abbreviations

IL

IL= interleukin

TNF

tumour necrosis factor.

We would like to thank Dr Wiedermann for his interest in our paper [1].

It is well established that IL-6 has been associated with anti-inflammatory properties, as pointed out by Dr Wiedermann. Although not a proinflammatory cytokine, IL-6 is produced by several cells as a result of previous stimulation by tumour necrosis factor (TNF)-α and IL-1. Therefore, the concentration of IL-6 has been considered to be a marker of the inflammatory reaction, as well as the preceding TNF-α and IL-1 responses, and in several studies it was shown to correlate with prognosis in patients with severe sepsis and septic shock [2, 3, 4]. Furthermore, persistently elevated levels of IL-6 have been associated with the development of multiple organ dysfunction syndrome [5].

The primary end-point of our study was to investigate whether the biological effects of endotoxin, as measured using TNF-α and IL-6 responses, could be neutralized by antibiotics. The early peak cytokine response after 1 hour (for TNF-α) and 2 hours (for IL-6) was chosen because both antibiotics in vitro had been shown to induce protection against oxidative injury, which induces an inflammatory response that might influence the results. A secondary end-point was whether the antibiotic treatment could affect cytokine concentrations in an animal model. The lower concentration of IL-6 during the last period of the experiment might be consistent with a reduction in oxidative stress and a concomitant proinflammatory response. In comparison with IL-6, the TNF-α response is often of lesser magnitude and of more transient character, which increases the statistical β error and makes it more difficult to demonstrate a reduction even if there is one.

It was emphasized that our data did not rule out other mechanisms. However, even if IL-6 does not have proinflammatory properties per se, then the most likely explanation was that IL-6 indicated the presence of an inflammatory response and that the reduction in IL-6 represented an anti-inflammatory effect caused by tobramycin and ceftazidime.

Notes

References

  1. 1.
    Wiedermann F: Anti-inflammatory effects of the antibiotics ceftazidime and tobramycin in porcine endotoxin shock: are they really anti-inflammatory? [Letter.]. Crit Care 2004, in press.Google Scholar
  2. 2.
    Waage A, Brandtzaeg P, Halstensen A, Kierulf P, Espevik T: The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin-6, interleukin-1 and fatal outcome. J Exp Med 1989, 169: 333-338.CrossRefPubMedGoogle Scholar
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    Casey LC, Balk RA, Bone RC: Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 1993, 119: 771-778.CrossRefPubMedGoogle Scholar
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    Reinhart K, Bayer O, Brunkhorst F, Meisner M: Markers of endothelial damage in organ dysfunction and sepsis. Crit Care Med 2002, Suppl: 302-312. 10.1097/00003246-200205001-00021CrossRefGoogle Scholar
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Copyright information

© BioMed Central Ltd 2004

Authors and Affiliations

  • Gunilla Goscinski
    • 1
  • Miklos Lipcsey
    • 2
  • Mats Eriksson
    • 3
  • Anders Larsson
    • 4
  • Eva Tano
    • 5
  • Jan Sjölin
    • 6
  1. 1.MD, Section of Infectious Diseases, Department of Medical SciencesUppsala University HospitalUppsalaSweden
  2. 2.MD, Department of Anesthesiology and Intensive CareGävle-Sandviken County HospitalGävleSweden
  3. 3.Associate Professor, Section of Anesthesiology & Intensive Care, Department of Surgical SciencesUppsala University HospitalUppsalaSweden
  4. 4.Associate Professor, Section of Clinical Chemistry, Department of Medical SciencesUppsala University HospitalUppsalaSweden
  5. 5.Biomedical Scientist, Section of Clinical Microbiology, Department of Medical SciencesUppsala University HospitalUppsalaSweden
  6. 6.Associate Professor, Section of Infectious Diseases, Department of Medical SciencesUppsala University HospitalUppsalaSweden

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