Clinical Review, BMJ 2007;335:929-932 (3 November).
Summary points
- A favourable outcome depends on early, aggressive, treatment
- Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
- Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
- Subtle signs of organ hypoperfusion should be sought in physically robust patients
- The role of activated protein C and low dose steroids remains to be clarified
