Abstract This study was designed to answer the three following questions: (1) Are glucocorticoids as protective in Gram-negative bacteremic shock as they are in endotoxic shock? (2) Is there any difference in efficacy between a bacteriostatic and a bactericidal antibiotic in bacteremic shock? (3) Does the combination of glucocorticoid with antibiotic potentiate the individual protective effects of both? Bacteremia was induced in male Sprague-Dawley rats by a single intravenous injection of viable Escherichia coli. The results showed that dexamethasone sodium phosphate alone afforded significant protection against Gram-negative bacteremic shock up to eight hours after challenge. The choice of a bactericidal vs a bacteriostatic antibiotic did not influence the survival rates in this study. The survival rate was maximal when dexamethasone was used with both ampicillin sodium and gentamicin sulfate. References 1. Wolff SM, Bennett JV: Gram-negative-rod bacteremia , editorial. N Engl J Med 291:733-734, 1974.Crossref 2. Myerowitz RL, Medeiros AA, O'Brien TF: Recent experience with bacillemia due to Gram-negative organisms . J Infect Dis 124:239-246, 1971.Crossref 3. Fukuda T, Hata N: Mechanisms of endotoxin shock in rats and the anti-endotoxic effect of glucocorticoids and endotoxin-conditioning . Jap J Physiol 19:509-520, 1969.Crossref 4. Loggie JMH, Privitera PJ, Sugarman S, et al: Effects of hydrocortisone on survival in neonatal beagles given endotoxin . Proc Soc Exp Biol Med 128:326-329, 1968.Crossref 5. Woodruff P, Caridis D, Cuevas P, et al: Corticosteroid treatment of major trauma: Mechanisms involved in their therapeutic effect . Arch Surg 107:613-616, 1973.Crossref 6. Schildt BE, Löw H: Relationship between trauma, plasma corticosterone and reticuloendothelial function in anaesthetized mice . Acta Endocrinol (Kbh) 76:141-150, 1971. 7. Thomas L: Cortisone and infection . Ann NY Acad Sci 56:799-814, 1953.Crossref 8. Cooper MR, DeChatelet LR, McCall CE: The in vitro effect of steroids on polymorphonuclear leukocyte metabolism . Proc Soc Exp Biol Med 141:986-990, 1972.Crossref 9. North RJ: The action of cortisone acetate on cell-mediated immunity to infection . J Exp Med 134:1485-1500, 1971.Crossref 10. Klastersky J: Effectiveness of adrenal corticosteroids in the management of severe bacterial infections . Rev Eur Etud Clin Biol 16:413-417, 1971. 11. Goodman LS, Gilman AG (eds): Pharmacological Basis of Therapeutics , ed 4. New York, Macmillan Co, 1970, pp 1223, 1298. 12. Garrod LP, O'Grady F: Antibiotic and Chemotherapy , ed 3, Baltimore, Williams & Wilkins Co, 1971. 13. Schumer W, Erve PR: Endotoxin sensitivity of adrenalectomized rats treated with lead-acetate . J Reticuloendothel Soc 13:122-125, 1973. 14. Fisher RA: Statistical Methods for Research Workers , ed 11. New York, Hofner Publishing Co, 1950. 15. Lillehei RC, Motsay GJ, Dietzman RH: Use of corticosteroids in the treatment of shock . Int J Clin Pharmacol 54:423-433, 1972. 16. Klastersky J, Cappel R: Adreno-corticosteroids in the treatment of bacterial sepsis: A double-blind study with pharmacological doses . Antimicrob Agents Chemother 10:175-180, 1971. 17. Webel ML, Ritts RE, Jr, Taswell HF, et al: Cellular immunity after intravenous administration of methylprednisolone . J Lab Clin Med 83:383-392, 1974. 18. Olds JW, Reed WP, Eberle B, et al: Corticosteroids, serum, and phagocytosis: In vitro and in vivo . Infect Immun 9:524-529, 1974. 19. Holtzman S, Schuler J, Earnest W, et al: Carbohydrate metabolism during endotoxemia . Circ Shock 1:99-105, 1974. 20. Weissmann G: Labilization and stabilization of lysosomes . Fed Proc 53:1038-1044, 1964. 21. Motsay GJ, Alho A, Jaeger T, et al: Effects of corticosteroids on the circulation in shock: Experimental and clinical results . Fed Proc 29:1861-1873, 1970.
Archives of Surgery – American Medical Association
Published: Aug 1, 1975