Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years.

INTRODUCTION: The last five years, there have been considerable changes in our perception on the pathogenesis of sepsis. This review aims to summarize the current progress of the last five years in the management and research fields of sepsis in a holistic approach. To achieve this, accumulated evidence over the last five years coming from randomized clinical trials (RCTs) and observational studies in adults for the management of sepsis is provided. Areas covered: In this review, the authors discuss available strategies in sepsis, divided into standard-of-care and adjunctive therapies. Standard-of-care approaches comprise antimicrobials, fluids, vasoactive agents, steroids. Antimicrobials remain the mainstay of treatment. However, key-point of management is early recognition of the patient that guides early start of antimicrobials. Patients with suspected infection and any two of: an altered mental state, more than 22 breaths per minute and systolic blood pressure below 100 mmHg should receive early intervention with broad-spectrum antimicrobials and fluids. Expert opinion: Low dose hydrocortisone replacement and fludrocortisone seem promising for the patient at septic shock. Adjunctive macrolide treatment of severe CAP is also associated with survival benefit. Future studies will help to provide additional insight into the field.