• Evangelos J Giamarellos-Bourboulis.
• 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece. egiamarel@med.uoa.gr
• Int. J. Antimicrob. Agents. 2013 Jun 1; 42 Suppl: S45-7.

AbstractThe failure of the PROWESS-SHOCK study of recombinant human activated protein C (drotrecogin alfa) has generated much scepticism about the future of immunomodulatory interventions in sepsis. This review presents a summary of the few remaining promising strategies for immunointervention. These comprise intravenous clarithromycin, haemoperfusion through a polymyxin B-embedded fibre device (PMX-B), recombinant thrombomodulin (rTM) and intravenous immunoglobulin preparations enriched in IgM and IgA (IgMA). The great heterogeneity in the pathophysiology of sepsis mandates a highly individualised approach. This approach comprises: septic shock and multiple organ dysfunction syndrome arising in the field of ventilator-associated pneumonia as an indication for intravenous clarithromycin; abdominal severe sepsis/shock for PMX-B haemoperfusion; sepsis and acute coagulopathy for rTM; and early septic shock for IgMA. However, specific diagnostic tools should be developed to make this personalised approach more robust.Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

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