Last update:
07-Jul-2004

Τhe modern concept of the effective management of the septic patient involves support with fluids, artificial respiration and inotropic agents and removal of the septic focus. This latter goal may be achieved by either surgical eradication of the septic focus or the effective administration of antimicrobial agents such as carbapenems or a combination of 3rd generation cephalosporins and aminoglycosides. The selection of an antimicrobial agent should be made cautiously since it could potentiate the septic process due to the release of endotoxins during lysis of the bacterial cell. β-lactams, which act through PBP-2 on the bacterial cell wall, such as cefuroxime, cefotaxime and ceftazidime, induce less release of endotoxins than carbapenems and quinolones. Other lines of causative management of sepsis involve immunomodulation. Monoclonal antibodies and soluble receptors of TNFα, inhibitors of nitric oxide synthase and polyunsaturated fatty acids have already been used. The intravenous administration of recombinant protein C has been proved the most effective immunomodulatory intervention. Its application is based on its inhibitory effect on the biosynthesis of pro-inflammatory cytokines. Better insight into the pathogenetic mechanisms of sepsis could lead to improved immunomodulatory therapy.

Key words: Antimicrobial agents, Cytokines, Immunomodulation, Sepsis.