Antibiotic-induced release of endotoxin. A therapeutic paradox.

Abstract:

:There is clear experimental evidence that antibiotics increase the bioavailability of endotoxin from Gram-negative bacteria. In this review, data for 2 variables, level of endotoxin and level of bacteria, at the time point closest to 2 hours post-antibiotic exposure were abstracted as a change from baseline readings from each available study, to enable presentation in a graphical overview. This overview indicates that the phenomenon is not limited to beta-lactam agents nor is it apparent only for the more rapidly bactericidal agents. However, evidence that this phenomenon is of clinical importance is scant. With the Jarisch-Herxheimer reaction (JHR), there is clear evidence for an acute deterioration with the initiation of antibiotic therapy and yet uncertainty as to the nature of the bacterial mediator(s) of this reaction. There is no evidence to support the commonly stated concern that therapy with antibiotics with a more rapid bactericidal action may result in the sudden lysis of bacteria with the release of cell wall components and cause a deterioration that might be avoidable through the use of antibiotics with a slower time course of action.

journal_name

Drug Saf

journal_title

Drug safety

authors

Hurley JC

doi

10.2165/00002018-199512030-00004

subject

Has Abstract

pub_date

1995-03-01 00:00:00

pages

183-95

issue

3

eissn

0114-5916

issn

1179-1942

journal_volume

12

pub_type

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