Immunomodulating effects of antibiotics used in the prophylaxis of bacterial infections in advanced cirrhosis |
| |
Authors: | Pedro Zapater José Manuel González-Navajas José Such Rubén Francés |
| |
Affiliation: | Pedro Zapater, José Manuel González-Navajas, Rubén Francés, CIBERehd, Hospital General Universitario de Alicante, 03010 Alicante, Spain;José Such, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates;Rubén Francés, Departamento Medicina Clínica, Universidad Miguel Hernández, 03550 San Juan, Spain |
| |
Abstract: | The use of norfloxacin either as primary or secondary prophylaxis of bacterial infections in advanced cirrhosis has improved patient’s survival. This may be explained not only due to a significant decrease in the number of infections, but also because of a direct immunomodulatory effect. Selective intestinal decontamination with norfloxacin reduces translocation of either viable bacteria or bacteria-driven products from the intestinal lumen. In addition, norfloxacin directly modulates the systemic inflammatory response. The pro-inflammatory cytokine profile secreted by neutrophils from these patients shows a close, significant, and inverse correlation with serum norfloxacin levels. Similar effects have been described with other quinolones in different clinical conditions. Although the underlying mechanisms are not well defined for most of the antibiotics, the pathways triggered for norfloxacin to induce such immunomodulatory effects involve the down-regulation of pro-inflammatory inducible nitric oxide synthase, cyclooxygenase-2, and NF-κB and the up-regulation of heme-oxygenase 1 and IL-10 expression. The knowledge of these immunomodulatory effects, additional to their bactericidal role, improves our comprehension of the interaction between antibiotics and the cellular host response and offer new possibilities for the development of new therapeutic strategies to manage and prevent bacterial infections in cirrhosis. |
| |
Keywords: | Cirrhosis Prophylaxis Cytokines Bacterial DNA Norfloxacin |
本文献已被 CNKI 等数据库收录! |
|