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The clinical significance of endotoxin released by antibiotics: what is the evidence?

Department of Surgery, University of Washington, Seattle, Washington, USA

G.J. Jurkovich

Department of Surgery, University of Washington, Seattle, Washington, USA

D. Dries

Department of Surgery, Loyola University, Maywood, Illinois, USA

R.V. Maier

Department of Surgery, University of Washington, Seattle, Washington, USA

Basic investigations indicate variation among antibiotics in their propensity to release endotoxin from bacterial cells. Evidence for the clinical significance of this phenomenon includes: anecdotal reports; studies evaluating changes in endotoxin levels in response to antibiotics in a variety of infectious diseases; two studies which have prospectively evaluated changes in endotoxin levels in response to different antibiotics and correlated the changes with the patients' clinical course; and one study which evaluated differences in mortality in injured patients based on the endotoxin-releasing potential of antibiotics they received. These studies suggest: (i) different types of antibiotics do induce differing levels of endotoxin release during treatment of bacterial infections in humans; (ii) such antibiotic-associated endotoxin release probably does have a biologic consequence; and (iii) this biologic consequence is possibly of clinical relevance. However, the data are not sufficient to advocate changes in current antibiotic prescribing or dosing decisions. Rather, a variety of in vitro and in vivo experiments as well as clinical studies are advocated.

Journal of Endotoxin Research, Vol. 3, No. 3, 253-259 (1996)
DOI: 10.1177/096805199600300311


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