Immunomodulating effects of antibiotics used in the prophylaxis of bacterial infections in advanced cirrhosis.

Publisher: Baishideng Publishing Group Country of Publication: United States NLM ID: 100883448 Publication Model: Print Cited Medium: Internet ISSN: 2219-2840 (Electronic) Linking ISSN: 10079327 NLM ISO Abbreviation: World J Gastroenterol Subsets: MEDLINE

Publication: 2014- : Pleasanton, CA : Baishideng Publishing Group
Original Publication: Beijing : WJG Press, c1998-

Antibiotic Prophylaxis*; Anti-Bacterial Agents/*administration & dosage ; Bacteria/*drug effects ; Bacterial Infections/*prevention & control ; Immunologic Factors/*administration & dosage ; Liver Cirrhosis/*drug therapy ; Norfloxacin/*administration & dosage; Animals ; Bacteria/immunology ; Bacteria/pathogenicity ; Bacterial Infections/diagnosis ; Bacterial Infections/immunology ; Bacterial Infections/microbiology ; Bacterial Translocation/drug effects ; Gastrointestinal Microbiome/drug effects ; Host-Pathogen Interactions/drug effects ; Humans ; Inflammation Mediators/immunology ; Intestines/drug effects ; Intestines/immunology ; Intestines/microbiology ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/immunology ; Treatment Outcome

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.

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Keywords: Bacterial DNA; Cirrhosis; Cytokines; Norfloxacin; Prophylaxis

0 (Anti-Bacterial Agents)
0 (Immunologic Factors)
0 (Inflammation Mediators)
N0F8P22L1P (Norfloxacin)

Date Created: 20151112 Date Completed: 20161031 Latest Revision: 20181113

20240628

PMC4631956

10.3748/wjg.v21.i41.11493

26556982