Antibiotics as biological response modifiers.

This review suggests that infections are potent immunomodulators by causing significant alterations in one or more mediators of homeostasis and that an effective antibiosis may be a potent immunomodulator, albeit indirectly. When large numbers of microorganisms are killed, their enzymes and toxins are rapidly released and activate the immune system. The septic syndrome and the potentially progressive states of septic shock, acute respiratory distress syndrome and multiple organ system failure illustrate the biological response modulating (BRM) activity of both infection and antibiotic. Enhancement of phagocytosis and intracellular killing would be a useful immunomodulatory activity for antibiotics. Equally useful would be the capacity of the antibiotic to bind or inactivate bacterial lipopolysaccharide (LPS) to diminish monocyte release of tumour-necrosing factor (TNF) at a rate equal to or faster than the killing effect of the antibiotic on bacteria. For other types of immune deficiencies, such as are observed in HIV-positive patients with secondary bacterial, fungal and viral infections, modulation of viral receptors including HIV-R on CD4 lymphocytes accompanied by their up-regulation, enhancement of interferon (IFN) and natural killer (NK) function and inhibition of CD8 suppressor activity would be important activities. The classic example of polymyxin as an immunomodulating, albeit toxic, antibiotic offers a rational and definitive basis for the concept. In-vitro data on cefodizime, a third generation cephalosporin that achieves good tissue levels, are presented and show the ability of the intact antibiotic, as well as its immunomodulating side-chain, to down-regulate TNF and interleukin 1 (IL-1) released from human monocytes by lectin-activated lymphocytes, LPS and IFN.