Systemic Inflammatory Response Syndrome Medication

  • Author: Steven D Burdette, MD, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM   more...
 
Updated: Apr 11, 2012
 

Medication Summary

No drugs of choice exist for systemic inflammatory response syndrome (SIRS). Medication prescriptions target specific diagnoses, preexisting comorbidities, and prophylaxis regimens for complications. No pharmacologic agents have been demonstrated to improve the outcome of SIRS.

Because of increasing bacterial resistance, when an infectious cause for SIRS is a concern but no specific infection has been diagnosed, broad-spectrum antibiotics should be administered. Therapy for methicillin-resistant Staphylococcus aureus (MRSA) should be considered, owing to the rising prevalence of MRSA in the community.

Insulin therapy (in patients with hyperglycemia) and steroids should also be considered in patients who meet criteria for SIRS.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. The therapy should be guided by available practice guidelines and knowledge of the local antibiogram, as well as the patient's risk factors for resistant pathogens and allergies. The key is to stop antibiotics when infection is ruled out or narrow the antibiotic spectrum once a pathogen is found.

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Cefepime (Maxipime)

 

Cefepime, a fourth-generation cephalosporin, is used for the treatment of Pseudomonas infections. Its gram-negative coverage is comparable to that of ceftazidime, and cefepime has better gram-positive coverage. Cefepime is a zwitter ion that rapidly penetrates gram-negative cells. It is the best beta-lactam antibiotic for intramuscular (IM) administration. Cefepime's poor capacity to cross the blood-brain barrier precludes the drug's use for meningitis treatment.

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Vancomycin

 

Vancomycin is used to treat enterococcal infections when ampicillin is contraindicated because of significant penicillin allergy and when strains are resistant to ampicillin but susceptible to vancomycin. Target levels of 30-50 µg/mL (peak) and 10-15 µg/mL (trough) for endocarditis and other serious infections.

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Levofloxacin (Levaquin)

 

Levofloxacin, a second-generation quinolone, acts by interfering with deoxyribonucleic acid (DNA) gyrase in bacterial cells. A bactericidal drug, levofloxacin is highly active against gram-negative and gram-positive organisms, including Pseudomonas aeruginosa.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune system to diverse stimuli. The initial research in sepsis and septic shock showed a trend toward worse outcomes when treating with high doses of steroids (methylprednisolone sodium succinate 30 mg/kg every 6 h for 4 doses) compared with placebo. However, research into low-dose steroids (200-300 mg of hydrocortisone for 5-7 days) improved survival and the reversal of shock in vasopressor-dependent patients.

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Hydrocortisone sodium succinate or phosphate (Cortef, Solu-Cortef)

 

This is the drug of choice for steroid replacement in acute adrenal crisis and for daily maintenance in patients with Addison disease or secondary adrenocortical insufficiency. It has glucocorticoid and mineralocorticoid properties. The biologic half-life is 8-12 hours. The easiest way to set up an infusion is to have the pharmacy mix 100 mg of hydrocortisone in 100 mL of 0.9% saline.

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Antidiabetic Agents

Class Summary

These agents are used to treat hyperglycemia. A reduction of in-hospital mortality rates by 34% has been reported with intensive insulin therapy (maintenance of blood glucose at 80-110 mg/dL.

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Insulin regular human (Humulin, Novolin, Humalog)

 

This is an ultra–short-acting insulin analog. Insulin suppresses hepatic glucose output and enhances glucose uptake by peripheral tissues. Insulin also suppresses ketogenesis and lipolysis, stimulates proper use of glucose by the cells, and reduces blood sugar levels.

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Antifungals, Systemic

Class Summary

Empiric antifungal therapy (fluconazole or an echinocandin) can be considered in patients who have already been treated with antibiotics, patients who are neutropenic, patients who are receiving total parenteral nutrition (TPN), or patients who have central venous access in place.

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Fluconazole (Diflucan)

 

Fluconazole is a synthetic triazole antifungal (broad-spectrum bistriazole) that selectively inhibits fungal CYP450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol. It is used to treat mild-to-moderate infections or severe or life-threatening infections in patients intolerant of amphotericin B. Metabolic clearance is prolonged in renal dysfunction.

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Caspofungin (Cancidas)

 

Caspofungin is the first of a new class of antifungal drugs (glucan synthesis inhibitors). It inhibits synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall. It is used to treat refractory invasive aspergillosis.

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Contributor Information and Disclosures
Author

Steven D Burdette, MD, FIDSA  Associate Professor of Medicine, Program Director, Infectious Diseases Fellowship, Wright State University, Boonshoft School of Medicine; Infectious Disease Advisor to Transplant Program, Miami Valley Hospital; Medical Director of Infectious Diseases, Green Memorial Hospital

Steven D Burdette, MD, FIDSA is a member of the following medical societies: Alpha Omega Alpha, American Society for Microbiology, American Society of Transplantation, Infectious Diseases Society of America, and Transplantation Society

Disclosure: Cubist Honoraria Speaking and teaching; Genentech Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Optimer Honoraria Speaking and teaching

Coauthor(s)

Miguel A Parilo, MD, FACP  Associate Clinical Professor of Medicine, Department of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, The Bull Family Diabetes Center

Disclosure: Sanofi-Aventis Honoraria Speaking and teaching; Amylin Honoraria Speaking and teaching

Lewis J Kaplan, MD, FACS, FCCM, FCCP  Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine

Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM  Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair of Academic Affairs, Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine

Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, European Society of Intensive Care Medicine, Shock Society, and Society of Critical Care Medicine

Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

Additional Contributors

Heatherlee Bailey, MD Assistant Program Director, Assistant Professor, Department of Emergency Medicine, Division of Critical Care, Medical College of Pennsylvania Hahnemann University

Heatherlee Bailey, MD is a member of the following medical societies: American Academy of Emergency Medicine, Association for Surgical Education, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Venn diagram showing overlap of infection, bacteremia, sepsis, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction.
 
 
 
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