Corticotherapy as adjunctive therapy for sepsis

Sepsis is an important cause of morbidity and mortality in the world. While the treatment of severe infections is based on the control of the cause, mainly through appropriate antibiotic therapy, corticosteroid therapy is the only adjuvant treatment which has demonstrated a beneficial effect on patient outcomes. Severe infections are accompanied by a local and systemic inflammatory response which is responsible for organ failure at a distance from the infectious site.Initial hypercorticism is a fundamental mechanism of adaptation to sepsis and the initial peak of cortisolemia is correlated with the severity of infection. In patients with refractory septic shock, hydrocortisone therapy should be prescribed at a dose of 200 to 300 mg/day to accelerate withdrawal from vasopressor amines and to reduce intra-hospital mortality. In cases of acute bacterial community meningitis, dexamethasone should be injected immediately before or concomitantly with the first antibiotic injection to decrease sequelae. For patients with acute respiratory distress syndrome without improvement after 7 days of adequate treatment, prolonged corticosteroid treatment may be given. For patients with severe community-acquired bacterial pneumonia, systemic corticosteroid therapy could be associated with antibiotic therapy to prevent aggravation and respiratory failure. In conclusion, in addition to controlling the focus of the infection, adjuvant glucocorticoid treatment decreases the morbidity, and probably the initial mortality, of patients with severe infection.