Early identification and treatment of septic shock to save lives

(Medical Xpress) -- Recognition of severe septic shock early and starting a patient on an effective antibiotic treatment immediately is critical to saving lives, according to an editorial by two Virginia Commonwealth University physicians published in the May 31 issue of the New England Journal of Medicine.

In the editorial, Richard P. Wenzel, M.D., professor in the Department of in the VCU School of Medicine, and Michael B. Edmond, M.D., M.P.H., chair of the Division of , noted that approximately 20 adjuvant drugs, apart from , have failed in trials of in the last two decades. They concluded that new therapies will emerge only from a “more crystalline view of the biology of sepsis.”

Wenzel and Edmond based their observations on a multi-institutional study of a controversial drug for sepsis known as drotrecogin alfa. According to Wenzel and Edmond, the weight of evidence now should “end any further pursuit of a niche for Human Activated Protein C in sepsis.”

According to Wenzel, an initial study in 2001 of the drug showed modest success in treating sepsis. However, the favorable outcome of slightly reduced mortality could not be replicated in lower risk adult patients or in children with sepsis. The international team testing the new drug proceeded to enroll a large number of patients with the most severe stage of sepsis - - and waited for at least four hours of shock to enroll them. The drug had no effect on mortality different from the placebo. However, both study groups received antibiotic therapy.

Based on their analysis, Wenzel and Edmond noted that in studying mortality from an acute infection like sepsis, investigators fail to consider the component of death from infection separate from the component from underlying diseases.

“In other words, some people die with sepsis but not from it, and they die because they have serious underlying diseases like lung or heart disorders or cancer,” said Wenzel.

The VCU team showed that failing to consider each component leads to errors in calculating the necessary number of subjects in a clinical trial. However, Wenzel and Edmond also said that the trends in the recent trial were slightly in favor of placebo being safer that the drug.

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Determine patient preferences by means of conjoint analysis

21 hours ago

The Conjoint Analysis (CA) method is in principle suitable to find out which preferences patients have regarding treatment goals. However, to widely use it in health economic evaluations, some (primarily methodological) issues ...

FDA approves hard-to-abuse narcotic painkiller

Jul 25, 2014

(HealthDay)—A new formulation of a powerful narcotic painkiller that discourages potential abusers from snorting or injecting the drug has been approved by the U.S. Food and Drug Administration.

Race affects opioid selection for cancer pain

Jul 25, 2014

(HealthDay)—Racial disparities exist in the type of opioid prescribed for cancer pain, according to a study published online July 21 in the Journal of Clinical Oncology.

FDA approves tough-to-abuse formulation of oxycodone

Jul 25, 2014

(HealthDay)—Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride extended release) has been approved by the U.S. Food and Drug Administration as a long-term, around-the-clock treatment for severe ...

User comments