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Effects of antibiotics on the intestinal microcirculation in septic rats

  • Although the benefit of expedient antibiotic therapy remains unquestioned, little is known about the effects that are unrelated to their antimicrobial property but which the antibiotics may exert upon the septic microcirculation. Impairment of intestinal microcirculation has been recognized as an important factor in the pathogenesis of the septic syndrome (intestine = ¡°motor¡± of multiple organ failure). To examine the effects of various antibiotics on microcirculation is justified by the fact that one of major features of sepsis is disturbance of microcirculation. However, monitoring of pharmacological effects on intestinal blood flow is nearly impossible during acute therapy in humans and requires sophisticated equipment when applied to experimental animals. Therefore, the aim of this study was to evaluate the effects of common antibiotics on intestinal microcirculation using intravital microscopy (IVM) and on the release of the cytokines in septic and endotoxemic rats. In a first series of experiments we induced sepsis by using colon ascendens stent peritonitis (CASP) model in the rat (16 hours prior microscopy). We evaluated the effects of common antibiotics on intestinal microcirculation using intravital microscopy (functional capillary density (FCD) and leukocyte-endothelial interactions) and on the release of the cytokines TNF-¥á, IL-1©¬, IL-6 and IL-10. Metronidazole (MET) (10 mg/kg); imipenem (IMI) (20 mg/kg); tobramycin (TOB) (25 mg/kg); vancomycin (VAN) (70 mg/kg); and erythromycin (ERY) (5 mg/kg) were given intravenously 16 hours following sepsis induction. To differentiate antimicrobial from anti-inflammatory effects we performed a second series of experiments using endotoxin (LPS, i. v.) and intravital microscopic examination was performed 2 hours later. Cytokine release was estimated at the end of the experiments. In the CASP model, acute administration of metronidazole was associated with an improvement of markers of the intestinal microcirculation in septic rats (CASP). Our study showed that vancomycin stimulated leukocyte rolling, while erythromycin prevented the activation of leukocyte-endothelial interaction in postcapillary intestinal venules (V1) that occurred within 16 hours after CASP. TNF-¥á release in untreated CASP rats was twice as high in comparison to all antibiotic-treated CASP rats, except in CASP rats treated with tobramycin. Key findings of the present study are that MET and ERY were more potent than other antibiotics in improving the intestinal microcirculation in the CASP model. Protective effects of metronidazole, erythromycin and vancomycin upon the microcirculation were found in LPS model. The administration of MET or VAN or ERY led to significantly higher FCD values within the longitudinal muscular layers. Metronidazole and erythromycin significantly reduced the n umber of sticking leukocytes within the V1-venules of LPS-challenged animals. Leukocyte rolling flux was significant increased within the V1- and V3-venules of the endotoxemic rats treated with VAN. Some antibiotics showed immuno-modulatory effects: MET or IMI or VAN treated LPS rats showed increased IL-10 levels; while ERY treated LPS rats showed decreased IL-1©¬ and increased IL-6 concentrations. In conclusion, metronidazole and erythromycin exerted a positive influence upon the intestinal perfusion not only within septic microcirculation (anti-bacterial effect) but also in a pathogenically independent manner (anti-inflammatory effect); vancomycin had only anti-inflammatory actions in the endotoxin model without bacterial infection. Imipenem and tobramycin had no effect on intestinal microcirculation in septic and endotoxemic rats. The clinical usefulness of studies such as this is that they could provide important information about possible side effects or indicate some potential beneficial effects of the antibiotics. They can influence not only microcirculation but also inflammatory processes by some mechanisms that are probably unrelated to their antibiotic effect. However, these effects may be particularly relevant to the intestinal microcirculation which plays an essential role in the development of multi-organ failure in the instance of sepsis.
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Author: Vo Hoai Bac
Advisor:Prof. Dr. Christian Lehmann
Document Type:Doctoral Thesis
Date of Publication (online):2006/12/05
Granting Institution:Ernst-Moritz-Arndt-Universität, Medizinische Fakultät (bis 2010)
Date of final exam:2006/11/27
Release Date:2006/12/05
Tag:antibiotics; endotoxemia; microcirculation; sepsis
GND Keyword:antibiotics, sepsis, endotoxemia, microcirculation
Faculties:Universitätsmedizin / Klinik für Anästhesiologie und Intensivmedizin
DDC class:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin und Gesundheit