Impact of co-amoxiclav on polymorphonuclear granulocytes from chronic hemodialysis patients

Phagocyte-dependent host defenses are frequently impaired in maintenance he modialysis patients who show an increased susceptibility to infections. In these individuals, the course of infections can be more aggressive than in normal hosts, and the antibiotic of choice should have a high antimicrobial effect without impairing host defenses. Hence, in uremic patients, the ant ibiotic enhancement of phagocyte functions may be of potential clinical imp ortance in the outcome of bacterial infections. Because we demonstrated pre viously that co-amoxiclav had beneficial properties that result in enhancem ent of the microbicidal functions of human polymorphonuclear cells (PMNs) f rom healthy subjects, we investigated the influence of this combination on the activities of PMNs from chronic hemodialysis patients against Klebsiell a pneumoniae, a human pathogen that can pose severe problems in patients wh ose immunity is impaired. PMNs from chronic dialysis patients showed a dimi nished in vitro phagocytic efficiency with a reduced phagocytosis and bacte ricidal activity towards intracellular K. pneumoniae compared with that see n in PMNs from healthy subjects, When co-amoxiclav was added to PMNs from c hronic hemodialysis patients, it was able to restore the depressed primary functions of PMNs, resulting in a significant high increase in both phagocy tosis or killing activity. A similar pattern was detected with PMNs collect ed from hemodialysis patients treated with co-amoxiclav. The results of the present study provide evidence that co-amoxiclav is able to induce stimula tion of depressed phagocytic response of PMNs from patients on chronic hemo dialysis, restoring their primary functions both in vitro and in vivo. (C) 2001 by the National Kidney Foundation, Inc.