Ocean State Clinical Coordinating Center
Publications
LaRosa SP. Sepsis: menu of new approaches replaces one therapy for all. Cleve Clin J Med 2002; 69 (1): 65-73.
Abstract
Effective therapies for sepsis are being devised, after many
failures. However, instead of a “one therapy for all” approach, management of sepsis will involve a menu of
treatments, depending on the presence of inflammatory
markers, the severity of disease, and other factors. This
article looks at promising new therapies, including
recombinant human activated protein C (rhAPC; drotrecogin
alfa, Xigris), recently approved by the US Food and Drug
Administration.
In a recent clinical trial, patients who received rhAPC had a
28-day mortality rate of 24.7%, compared with 30.8% in
the placebo group, a relative risk reduction of nearly 20%.
Of importance, at baseline, nearly all the patients in the
study had biochemical evidence of coagulopathy and
inflammation, 75% had two or more organ failures, and
70% were in septic shock.
Future therapies for sepsis could include corticosteroid
replacement therapy, enteral feeds containing arginine and
omega-3 fatty acids, intravenous infusions of Ringer’s ethyl
pyruvate solution, mechanical ventilation with low tidal
volumes, hemoperfusion columns that bind bacterial toxins,
and novel antiendotoxin and anti-inflammatory agents.
Sepsis is caused by cascades of inflammation and
coagulation in which tumor necrosis factor alpha and
interleukin-1 play a central role.
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