 |
|
A Critical Evaluation of New Agents for the Treatment of Sepsis
Roger C. Bone, MD
JAMA. 1991;266(12):1686-1691.
Abstract
| |
Objective.
—To evaluate new treatments directed against endotoxin, tumor necrosis factor  , and interleukin 1 for use in sepsis and related disorders (sepsis syndrome and septic shock).
Data Sources.
—Investigations of these treatments in animal models, healthy human volunteers, and patients with sepsis and related disorders.
Study Selection.
—Particular attention was paid to studies of patients with sepsis and related disorders, especially randomized, double-blind, controlled trials.
Data Extraction.
—Animal studies and investigations with human volunteers were judged by how closely the experimental model replicated the clinical disorder (sepsis). Patient trials were assessed by sample size and design. Results of all studies were used to evaluate the likelihood that a given treatment would reduce mortality.
Data Synthesis.
—Direct comparison of E5 and HA-1A antibody studies is difficult because of differences in their design, definitions of shock, and methods of subgroup analysis. However, both antibodies improve outcome in some subgroups: E5 benefits patients with gram-negative infection (bacteremic or focal) who do not have refractory shock, and HA-1A benefits those with gramnegative bacteremia (regardless of whether shock is present) but not those with focal gram-negative infection. Two agents that may be beneficial in gram-positive and gram-negative infection are monoclonal antibodies to tumor necrosis factor and receptor antagonists to interleukin 1. Preliminary results with both are reviewed.
Conclusions.
—All three types of treatment may improve outcome in sepsis. The best results will probably be obtained with combination therapy that interrupts multiple points of the inflammatory cascade underlying sepsis.
(JAMA. 1991;266:1686-1691)
Author Affiliations
From the Department of Internal Medicine, Section of Pulmonary Medicine, Rush-Presbyterian—St Luke's Medical Center, Chicago, Ill.
Footnotes
Reprint requests to Department of Internal Medicine, Section of Pulmonary Medicine, Rush-Presbyterian—St Luke's Medical Center, 1753 W Congress Pkwy, Chicago, L 60612 (Dr Bone).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Inhibition of Endotoxin Response by E5564, a Novel Toll-Like Receptor 4-Directed Endotoxin Antagonist
Mullarkey et al.
J. Pharmacol. Exp. Ther. 2003;304:1093-1102.
ABSTRACT
| FULL TEXT
A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin
Annane et al.
JAMA 2000;283:1038-1045.
ABSTRACT
| FULL TEXT
Induction of Adrenomedullin mRNA and Protein by Lipopolysaccharide and Paclitaxel (Taxol) in Murine Macrophages
Zaks-Zilberman et al.
Infect. Immun. 1998;66:4669-4675.
ABSTRACT
| FULL TEXT
Incidence, Risk Factors, and Outcome of Severe Sepsis and Septic Shock in Adults: A Multicenter Prospective Study in Intensive Care Units
Brun-Buisson et al.
JAMA 1995;274:968-974.
ABSTRACT
Nosocomial Bloodstream Infections: Secular Trends in Rates, Mortality, and Contribution to Total Hospital Deaths
Pittet and Wenzel
Arch Intern Med 1995;155:1177-1184.
ABSTRACT
The French National Registry of HA-1A (Centoxin) in Septic Shock: A Cohort Study of 600 Patients
The National Committee for the Evaluation of Cento
Arch Intern Med 1994;154:2484-2491.
ABSTRACT
The Clinical Evaluation of New Drugs for Sepsis: A Prospective Study Design Based on Survival Analysis
Knaus et al.
JAMA 1993;270:1233-1241.
ABSTRACT
Toward an Epidemiology and Natural History of SIRS (Systemic Inflammatory Response Syndrome)
Bone
JAMA 1992;268:3452-3455.
ABSTRACT
Infectious Diseases
Stoeckle and Douglas
JAMA 1992;268:366-368.
ABSTRACT
Modulators of Coagulation: A Critical Appraisal of Their Role in Sepsis
Bone
Arch Intern Med 1992;152:1381-1389.
ABSTRACT
|
