High-Dose Antithrombin III in Severe Sepsis: A Randomized Controlled Trial

Article Abstract:

Antithrombin III treatment does not appear to benefit patients who are in septic shock. Septic shock is shock caused by a severe bacterial infection, usually in the bloodstream. Antihrombin prevents the formation of blood clots, which researchers believed were the cause of multiple organ failure in these patients.

Septic shock, Enzyme inhibitors

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Monoclonal antibodies to endotoxin: new allies against sepsis?

Article Abstract:

Gram-negative sepsis is an extremely grave condition which affects many hospital patients. Gram-negative bacteria have particular chemical structures in their cell wall which cause toxic reactions in the infected individual. These chemical substances constitute the so-called endotoxin, and the presence of the endotoxin in the blood is Gram-negative sepsis. Often, but not always, culture of the blood will reveal the presence of Gram-negative organisms as well. Once Gram-negative sepsis has occurred, the risk of death is extremely high. Evidence is now accumulating to indicate that antibodies to the endotoxin may be used to reduce the risk of infection. This does not mean, however, that physicians should treat all cases of suspected Gram-negative sepsis with the antibodies. When the antibodies become commercially available, they are likely to be very expensive, and therefore treating patients not likely to benefit would be very costly. For example, patients who have gone into shock as a result of Gram-negative sepsis have not been shown to benefit, and they should therefore not be treated in this fashion. Furthermore, the costly antibodies should only be used if the Gram-negative sepsis has been confirmed or if the suspicion is very high. The antibodies should not be administered only because Gram-negative sepsis is considered to be a possibility. It should also be remembered that the research studies that have demonstrated some benefit resulting from administration of the antibodies have not found a benefit for all patients. That is, the antibodies are far from a cure for sepsis. Therefore, decisions about the administration of these antibodies should not be automatic but should always be based on the results of the clinical research and the best clinical judgment of the practicing physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Monoclonal antibodies, Bacteremia, editorial

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A critical evaluation of new agents for the treatment of sepsis

Article Abstract:

One of the most feared complications of critically ill patients, or those who have undergone surgery is severe sepsis, contamination or poisoning of the body caused by the products of infection. The incidence of sepsis is increasing and the death rate as a result of this condition remains high. Understanding of sepsis has improved as a result of new findings in microbiology. A review is presented of the development and some of the new treatments of sepsis. Three important factors in the development of sepsis are endotoxin, tumor necrosis factor alpha and interleukin 1. Endotoxin is a poison contained in the walls of gram-negative bacterial cells; it is released when the bacteria die and are broken down in the body. Endotoxin causes the release of tumor necrosis factor alpha and interleukin 1. Tumor necrosis factor alpha can stimulate the release of interleukin 1, and it can directly damage endothelial tissues, which line the heart and blood vessels. Interleukin 1 enhances tissue response to tumor necrosis factor alpha and is also toxic to the endothelial lining. New treatments include antibodies to endotoxin, antibodies to tumor necrosis factor alpha, and receptor antagonist to interleukin 1. Studies of the use of these treatments in animals, healthy people, and patients with sepsis are reviewed. These three treatments may be helpful in treating sepsis and reducing deaths, but the best results will probably be obtained by combination therapy, which can interrupt the sequence of events that occurs in the development of sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Development and progression, Endotoxins, Tumor necrosis factor, Interleukin-1, Immunotherapy

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