Giamarellos-Bourboulis E J, Perdios J, Gargalianos P, Kosmidis J, Giamarellou H
4th Department of Internal Medicine, University of Athens, Medical School, Athens General Hospital "G Gennimatas," Greece.
J Postgrad Med. 2003 Apr-Jun;49(2):118-22.
In vitro results have shown that antimicrobial agents may induce the Gram-negative bacteria to release endotoxins (LPS), which in turn, could trigger the secretion of cytokines from monocytes.
To compare the effect of cefuroxime, netilmicin or ciprofloxacin on serum levels of LPS and tumour necrosis factor-alpha (TNFalpha).
Seventy-four patients with acute pyelonephritis caused by Gram-negative bacteria and signs of sepsis were randomly assigned to receive one of three intravenous regimens of cefuroxime, netilmicin or ciprofloxacin. Blood samples were collected before therapy and at specified time intervals for 96 hours after the initiation of treatment for the determination of serum levels of LPS and of TNFalpha.
Patients treated with cefuroxime presented an early peak of LPS and of TNFalpha in serum two hours after the initiation of treatment compared to the other study groups. After that time interval, concentrations of LPS and TNFalpha were similar in all the study groups. Fever accompanied by endotoxaemia was still detected for 48 hours after the start of therapy in 36, 37.5 and 36% of patients treated with cefuroxime, netilmicin and ciprofloxacin respectively. The corresponding figures for these agents at 72 hours were 28, 12.5 and 24%, respective and 12, 4.2 and 4% at 96 hours (P value not significant).
With the exception of an early peak in the serum levels of LPS and TNFalpha in patients treated with cefuroxime, no significant difference could be detected amongst the study groups as far as their effect on serum levels of LPS and TNFalpha were concerned. This suggests that these three antimicrobial agents may be administered safely at the early stages of sepsis.
体外实验结果表明，抗菌药物可能诱导革兰氏阴性菌释放内毒素（脂多糖），进而引发单核细胞分泌细胞因子。
比较头孢呋辛、奈替米星或环丙沙星对血清脂多糖和肿瘤坏死因子-α（TNFα）水平的影响。
74例由革兰氏阴性菌引起急性肾盂肾炎且有败血症体征的患者被随机分配接受头孢呋辛、奈替米星或环丙沙星三种静脉用药方案中的一种。在治疗前及开始治疗后96小时内的特定时间间隔采集血样，以测定血清脂多糖和TNFα水平。
与其他研究组相比，接受头孢呋辛治疗的患者在开始治疗两小时后血清中脂多糖和TNFα出现早期峰值。在该时间间隔之后，所有研究组中脂多糖和TNFα的浓度相似。分别接受头孢呋辛、奈替米星和环丙沙星治疗的患者中，治疗开始后48小时仍分别有36%、37.5%和36%的患者出现伴有内毒素血症的发热。这些药物在72小时时的相应数字分别为28%、12.5%和24%，在96小时时分别为12%、4.2%和4%（P值无显著性差异）。
除接受头孢呋辛治疗的患者血清脂多糖和TNFα水平出现早期峰值外，就各研究组对血清脂多糖和TNFα水平的影响而言，未检测到显著差异。这表明这三种抗菌药物可在败血症早期安全使用。
