Non-antibiotic therapies for sepsis: an update

Introduction: Sepsis, defined as infection plus some degree of organ dysfunction, is still associated with high mortality and morbidity rates. Management focuses on three key areas: infection control, hemodynamic stabilization and organ support, and modulation of the sepsis response. Areas covered: This review will not cover infection control. Hemodynamic stabilization essentially involves the use of adequate fluid resuscitation and vasopressors. Fluid and vasopressor choices and targets are discussed, and the need to adapt these to the individual patient is stressed. No drugs are currently available that modulate the sepsis response, with the possible exception of corticosteroids in the most severe cases. The place of vasopressin is not well defined. Some of the immunomodulatory agents currently in development are briefly discussed. Expert opinion: Management of the patient with sepsis remains a challenge and needs to be personalized. The search for new immunomodulatory drugs continues and will be facilitated by better characterization of patients using modern 'omics' technology and complex analysis of the large quantities of clinical data increasingly available.