Emerging drugs in sepsis.
BACKGROUND
Sepsis remains a major cause of death in intensive care units. Despite an intense research, a new drug that is effective in reducing mortality in sepsis is still awaited.


METHODS
The literature was analyzed with Pubmed() during the 2008 - 2009 period. If required, seminal articles published before 2008 were cited. Clinical trials focusing on 'sepsis' were first assessed. Next, relevant experimental data in this field were reported.


RESULTS
The goal of the review is to determine the role for new licensed antibiotics, to give an insight into the conflict on adjuvant therapies and to disclose new experimental concepts.


CONCLUSIONS
New licensed antibiotics will offer the opportunity to refine the treatment choices. Direct hemoperfusion using polymyxin B-immobilized fiber column may be an option in sepsis due to Gram-negative bacilli. Among non-antibiotic drugs, new ongoing studies will clarify the role of drotrecogin alfa (activated) and low dose hydrocortisone. The modulation of monocytic human leukocyte antigen-DR seems the most prominent treatment. The use of cardiovascular drugs requires well-conducted clinical trials. The regulation of high mobility group box 1, adenosine blockade or correction of the impaired energy production is still at the experimental level.
Leone
Marc
M
Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrely, 13915 Marseille Cedex 20, France. marc.leone@ap-hm.fr
Textoris
Julien
J
Michel
Fabrice
F
Wiramus
Sandrine
S
Martin
Claude
C
D000818:Animals; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016503:Drug Delivery Systems / Q000379:methods*; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D015507:Drugs, Investigational / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D011112:Polymyxin B / Q000627:therapeutic use; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015398:Signal Transduction / Q000187:drug effects
D000890:Anti-Infective Agents; D002317:Cardiovascular Agents; D015507:Drugs, Investigational; D011486:Protein C; D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D011112:Polymyxin B; C421124:drotrecogin alfa activated; D006854:Hydrocortisone