Fusidin down-regulates the production of IL-6 in septic patients: a pilot study

Septic shock is characterized by pathophysiological derangements in the function of multiple organs. Many of the manifestations of shock have been related to high levels of circulating cytokines. Fusidic acid is an antiotic with a tetracyclic structure. Its chief clinical use is in the treatment of staphylococcal infections. It has been proposed, that the acid form as well as the sodium salt of the drug (Fusidin) possess antiinflammatory properties.

Aim

The present pilot study was carried out to test the hypothesis that fusidin downregulates the production of pro- and anti-inflammatory cytokines in septic patients. The study was approved by the Regional Ethical Committee and informed consent was obtained from each patient or a close relative.

Material and methods

Five consecutive septic patients received fusidin 500 mg × 3 i.v. for 1 day. Blood samples were drawn two times before fusidin administration, six times during the 24 h where fusidin was given and 24 h after the last dose. The pro-inflammatory cytokines IL-1a, IL-1b, TNFα and IL-6 and the antiinflammatory cytokines IL-10 were analysed using ELISA.

Results

Three females and two males were included, age 21–72 years (range). APACHE II score 13–24 (range). Two patients died in the ICU. No clinical or biochemical side effects were seen in relation to fusidin administration.

The proinflammatory cytokines IL-1b, TNF α and IL-6 and the antiinflammatory cytokine IL-10 were detectable in peripheral blood in all patients while IL-1a was undetectable. Treatment withfusidin was associated with a decline in plasma concentrations of IL-6 from 183 (78-293) to 116 (67-406) pg/ml 12 h later (median values with range) (P < 0.05). No changes occurred in the other cytokine levels. The measured cytokines were characterized by large interindividual variations.

Discussion

The results from this pilot study provide further in vivo evidence for the antiinflammatory properties of fusidin. Fusidin may be useful in the management of the systemic inflammatory response in septic patients.