Antibiotic-induced endotoxin release in patients with gram-negative urosepsis: a double-blind study comparing imipenem and ceftazidime

Jan M. Prins*, Michiel A. Van Agtmael, Ed J. Kuijper, Sander J.H. Van Deventer, Peter Speelman

*Corresponding author for this work

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The clinical significance of differences between antibiotics in endotoxin-liberating potential is unknown. Thirty patients with gram-negative urosepsis were randomized between imipenem and ceftazidime, which have, respectively, a low and a high endotoxin-liberating potential in vitro. In patients treated with ceftazidime, a slower defervescence was noticed. After 4 h of treatment, the blood endotoxin level decreased in all 3 endotoxemic patients receiving imipenem, whereas it increased in 2 of the 4 endotoxemic patients receiving ceftazidime, and in ceftazidime-treated patients, the endotoxin level in urine decreased less than in imipenem-treated subjects. Serum and urine cytokine levels increased 10%—40% after 4 h of ceftazidime treatment compared with no increase in the imipenem-treated patients (P >.05). Endotoxin release during antibiotic killing in vitro, assessed for all microorganisms, was to-fold higher with ceftazidime (P <.001). These results indicate that differences between antibiotics in endotoxin release may affect the inflammatory response during treatment.

Original languageEnglish
Pages (from-to)886-891
Number of pages6
JournalJournal of Infectious Diseases
Issue number3
Publication statusPublished - Sep 1995

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