TNF and Shock: In fact, according to serum analysis performed by Spyridaki et al., patients with septic shock and multiple organ failure who received clarithromycin had a lower ratio of serum IL-10 to TNF-α, although their monocytes showed higher IL-6 but lower TNF-α production in response to LPSs with increased apoptosis, and increased expression of the co-stimulatory molecule CD86 on day 4 after randomization [50].