Open Access

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

  • Gunilla Goscinski1Email author,
  • Miklos Lipcsey2,
  • Mats Eriksson3,
  • Anders Larsson4,
  • Eva Tano5 and
  • Jan Sjölin6
Critical Care20048:141

https://doi.org/10.1186/cc2815

Published: 5 February 2004

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 [24]. 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.

Abbreviations

IL: 

IL= interleukin

TNF: 

tumour necrosis factor.

Declarations

Authors’ Affiliations

(1)
MD, Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital
(2)
MD, Department of Anesthesiology and Intensive Care, Gävle-Sandviken County Hospital
(3)
Associate Professor, Section of Anesthesiology & Intensive Care, Department of Surgical Sciences, Uppsala University Hospital
(4)
Associate Professor, Section of Clinical Chemistry, Department of Medical Sciences, Uppsala University Hospital
(5)
Biomedical Scientist, Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University Hospital
(6)
Associate Professor, Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital

References

  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
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  4. Reinhart K, Bayer O, Brunkhorst F, Meisner M: Markers of endothelial damage in organ dysfunction and sepsis. Crit Care Med 2002, Suppl: 302-312. 10.1097/00003246-200205001-00021View ArticleGoogle Scholar
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Copyright

© BioMed Central Ltd 2004

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