Variability of immune response induced by bacteria treated with subminimal inhibitory concentrations of fosfomycin

Side effects of antibiotics on immune response parameters and their possible implications in antimicrobial chemotherapy

Antibiotics may influence immune response by quite different ways. By screening the multitude of publications on this subject, the aim of this overview was to arrive at a basic generalizing statement on the relationship between chemical structure or mode of action of antibiotics and the effect on immune response and to get an indication on whether certain in vitro and/or ex vivo parameters could represent comparable effects under clinical conditions. - The influence of antibiotics on immune response may arise by direct effects on immunocompetent cells, i.e. in the absence of microorganisms, or indirectly by changes in structure or metabolic products of germs induced by subminimal inhibitory concentrations (subMIC's). In the former case, stimulatory and inhibitory effects have been observed on phagocytosis and intracellular killing activity, on antibody production including IgE, on different parameters of cellular immunity (e.g. foodpad swelling reaction, MIF-production, mitogen/antigen induced lymphocyte proliferation and delayed type hypersensitivity skin reaction), on mediator production as interleukins or prostaglandins and the expression of corresponding receptors on immunocompetent cells as well as on the course of experimental infections with primary resistant microorganisms. - Indirect effects are related to the influence of subMIC's of antibiotics on the morphology and structure of microorganisms, on their antigenicity/immunogenicity or on their serosensitivity and enzyme and toxin production. - This overview shows that - according to the actual knowledge - antibiotics may exhibit immunological side effects which, however, can not strictly be attributed to certain chemical structures or to a certain mode of action. - It has to be considered that a literary study comparing the results of different authors is rendered difficult by the often nonhomogeneity of experimental procedures and the fact that little is known yet about immunological side effects of antibiotics in man, i.e. under clinical conditions.

Sublethal concentrations of antibiotics, effects on bacteria and the immune system

Biological specimens obtained from patients with infections that are treated with antibiotics at dosages that resulted in body fluid concentrations below those that are minimally inhibitory, exhibit abnormal forms of bacteria. Identical morphological changes can be induced in vitro when the parental normal forms of the bacteria. Identical morphological changes can be induced in vitro when the parental normal forms of the bacteria are exposed to subminimal concentrations of certain antibiotics. The phenomenon of induced abnormal morphology and ultrastructure has received consideration in terms of: (1) the relationship of the induced alterations of the specific bacterial species to the given antibiotic, (2) in vitro conditions required for antibiotic induced alterations, (3) the mechanisms of action; (4) immune responses to the abnormal forms, and (5) relationship between abnormal structure and the inhibition of bacterial replication. This review provides the reader with a description and the significance of current research in the above areas which together comprise the growing field of subinhibitory concentrations of antibiotics.