A review of safe and effective pharmacotherapies for paediatric and neonatal septic shock.

Abstract

Introduction: Sepsis is a clinical syndrome that occurs due to dysregulated host response to infection. Septic shock is the presence of cardiovascular dysfunction in the context of sepsis. Pediatric septic shock is an important cause of morbidity and mortality globally. Early recognition and prompt treatment has been shown to improve outcomes.

Areas covered: A comprehensive literature search was conducted using PubMed and Embase. Key search terms included 'Paediatric,' sepsis,' 'shock,' 'neonatal,' 'antimicrobial' and 'adjunctive therapy' from 1965 to date.

Expert opinion: The primary focus underlying management of neonatal and pediatric septic shock is rapid recognition and timely antibiotic and fluid therapy, with initiation of supportive treatments. Disappointingly, this management paradigm has not significantly changed in the last 20 years, despite efforts to develop novel adjunctive therapies.What has changed is the recognition that 'bundles of care' including rapid diagnosis, appropriate antibiotics, fluid resuscitation and initiation of supportive care can significantly improve outcomes.Molecular diagnostics have significantly improved the ability for effective antimicrobial stewardship. Initiatives such as the Surviving Sepsis Campaign have highlighted evidence-based practice. However, few new adjunctive therapies have been translated from research into clinical practice, but there are several potential advances in treatment modalities that will be discussed.