Sepsis adjunctive therapies

Pretreatment with monoclonal anti-TNF antibodies prevents mortality (B23, M32) and organ damage (M16) in experimental sepsis. In clinical studies using anti-TNF antibodies, however, the overall benefit of this treatment showed encouraging but no evident results (L22). Recently, the INTERSEPT study suggests a possible role for anti-TNF antibody as an adjunctive therapy, but with no reduction of mortality (C21). There is no plain cause-effect relation between TNF re-... 

Non-vaccine generated anti-endotoxin reagents that bind and/or neutralize LPS, such as bactericidal permeability increasing protein (BPI), endotoxin neutralizing protein (ENP), and cationic peptide 18 conjugated to immunoglobulin G (CAP 18-IgG) have been developed for the adjunctive therapy of sepsis, but only BPI has progressed to clinical trials (Levin et al., 2000). 

Hetastarch is a plasma expander that produces expansion of plasma volume. It does not have oxygen-carrying capacity or contain plasma protein, so it is not a blood or plasma substitute. It is indicated as an adjunct therapy for plasma volume expansion in shock caused by hemorrhage, bums, surgery, sepsis, or other trauma and as an adjunct in leukapheresis to improve harvesting and increase yield of granulocytes. 

Unlike Tx synthetase inhibitors and receptor antagonists, NSAIDs given alone or with other adjunctive therapy (discussed below) improve survival or survival time in the rat model of sepsis . The beneficial action of the cyclo-oxygenase inhibitors in these sepsis modelis must therefore be attributed to inhibition of other prostanoid metabolites, e.g. PGE2, id... 

Leukocytosis is a normal host defense to infection and is an important adjunct to antimicrobial therapy. Unfortunately, bacterial infection is a common complication of neutropenia from cancer chemotherapy. These patients are incapable of increasing their WBCs in response to infection. In fact, susceptibility to infection in these patients is highly dependent on their WBC status. Patients with neutrophil counts of less than 500 cells/mm are at high risk for the development of bacterial or fungal infections. The absence of leukocytosis also occurs in the elderly and in severe cases of sepsis. ... 

---