Comparative Effects of Ciprofloxacin and Ceftazidime on Cytokine Production in Patients with Severe Sepsis Caused by Gram-Negative Bacteria

Abstract

In the present study the effect of ciprofloxacin versus ceftazidime on concentrations of pro-and anti-inflammatory cytokines in the sera of patients with severe sepsis was evaluated. The study included 58 previously healthy patients suffering from severe sepsis caused by gram-negative bacteria, treated with either ciprofloxacin or ceftazidime after thorough clinical and microbiological evaluation and followed up for clinical outcome. Levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-␣), interleukin-1b (IL-1b), IL-6, and IL-8 and of the anti-inflammatory cytokine IL-10, as well as of IL-1 receptor antagonist and soluble TNF receptors I and II, in serum were measured at baseline and 24 and 48 h after the first antimicrobial dose. Mean SAPS-II scores, development of septic shock, and mortality rates were similar in the two groups (43.2 ؎ 9.2, 21.4%, and 14.3% in the ceftazidime group versus 49.8 ؎ 11.3, 20%, and 13.3% in the ciprofloxacin group). Serum TNF-␣ and IL-6 levels at 24 and 48 h were significantly lower in the ciprofloxacin group, while the IL-10/TNF-␣ ratio was significantly higher, than those for the ceftazidime group. Among patients with high baseline TNF-␣ levels, there were significant increases in the IL-10/TNF-␣ ratio at both 24 and 48 h over that at admission for the ciprofloxacin group, while no differences were noted in the ceftazidime group. These results indicate that ciprofloxacin may have an immunomodulatory effect on septic patients by attenuating the proinflammatory response, while there is no evidence that differences in the cytokines measured have any impact on the final outcome.

Role of Commiphora Mol Mol and Doxycycline in Prophylaxis of Spontaneous Bacterial Peritonitis in Egyptians Cirrhotic Patients

“…Group one showed significant decrease in IL-6 level three and six months after ciprofloxacin administration which agreed with reported findings that serum TNF-α and IL-6 levels were reduced significantly 24 and 48 h after ciprofloxacin treatment [28].…”

Use of blood urea nitrogen, creatinine, interleukin-6, granulocyte–macrophage colony stimulating factor in combination to predict the severity and outcome of abdominal sepsis in rats

“…Among a wide array of cytokines assessed so far, it was found that persistently elevated IL-6 values are associated with both multiple organ failure and high mortality [15,16]. However, in a study of cytokines in sepsis, the mortality rate was independent of the IL-6 levels [17]. In previous studies it has been shown that high IL-6 levels on admission [18] or subsequently [5] are seen in patients with severe sepsis and septic shock, and sequential measurement of blood IL-6 levels is useful in evaluating the severity and predicting the outcome of the patients with sepsis [19,20].…”

Quinolone-Induced Upregulation of Osteopontin Gene Promoter Activity in Human Lung Epithelial Cell Line A549

“…Moxifloxacin (MFX) inhibited IL-8, TNF-␣, and IL-1␤ production in THP-1 cells and in monocytes when preincubated with MFX and stimulated with lipopolysaccharide (LPS) (38). Another report suggested that ciprofloxacin (CIP) may have an immunomodulatory effect on septic patients by attenuating the proinflammatory response, thus decreasing TNF-␣, IL-6, IL-1␤, and IL-8 levels in patients' serum (15). Levofloxacin at concentrations of 100 g/ml and higher was found to dose dependently reduce the IL-6 and IL-8 levels in TNF-␣-stimulated NL20 human bronchial epithelial cells, but lower concentrations did not alter the studied cytokines (35).…”