A. J.H. SimpsonSteven M. OpalB. J. AngusJ. M. PrinsJ. E. PalardyN. A. ParejoW. ChaowagulN. J. WhiteMahidol UniversitySappasitthiprasong HospitalUniversity of OxfordThe Warren Alpert Medical School of Brown UniversityAcademic Medical Centre, University of AmsterdamMemorial Hospital of Rhode Island2018-09-072018-09-072000-04-19Journal of Infectious Diseases. Vol.181, No.3 (2000), 1014-1019002218992-s2.0-0034037592https://repository.li.mahidol.ac.th/handle/20.500.14594/26257Severe melioidosis is a life-threatening, systemic bacterial infection caused by Burkholderia pseudomallei. A prospective, randomized treatment trial was conducted in northeast Thailand to compare ceftazidime (a penicillin-binding protein [PBP]-3-specific agent that causes release of large amounts of endotoxin in vitro) and imipenem (a PBP-2-specific agent that kills B. pseudomallei more rapidly but releases low amounts of endotoxin) in severe melioidosis over a 6-h time course after the first dose of antibiotic. Despite similar clinical, microbiological, endotoxin, and cytokine measures at study entry, ceftazidime-treated patients (n = 34) had significantly greater systemic endotoxin (P < .001) than patients treated with imipenem (n = 34) after the first dose of antibiotic. No overall difference in mortality was observed (35% in both groups [95% confidence interval, 20%-50%]). Differential antibiotic-induced endotoxin release is demonstrable in severe melioidosis. These differences in endotoxin release did not appear to have a significant impact on survival in this group of patients.Mahidol UniversityMedicineArticleSCOPUS10.1086/315306