Sepsis Treatment: Medication, Lifestyle Changes, and More

Sepsis Treatment: Medication, Lifestyle Changes, and More

Sepsis Treatment: Medication, Lifestyle Changes, and More
Everyday Health
Sepsis is a rare complication of an infection for which there's an extreme immune system response, triggering widespread inflammation throughout the body. It may be mild or severe, but because sepsis is a potentially life-threatening illness, it requires immediate medical attention.

Symptoms of sepsis include a high fever, high heart rate, and fast breathing rate. As the infection progresses, some people experience difficulty breathing, stomach pain, confusion, and dizziness. Sepsis can lead to dangerously low blood pressure and organ failure (septic shock).

It’s important to seek treatment for sepsis right away, which may include medications and therapies to treat the underlying infection and other issues. Due to the gravity of this illness, sepsis isn’t something you treat at home. It requires an emergency room visit, followed by admission to the hospital with close monitoring and time-sensitive treatment.

If you already have a sepsis diagnosis, talk to your healthcare provider about the best treatment for you, as well as before you stop or change your treatment.

Medication

Septic treatment typically begins with antibiotics for the infection, which may be followed by medication to control blood pressure and other issues. “The major areas to focus on for the initial treatment of sepsis are to restore blood flow to vital organ systems and eliminate the inciting infection,” says Scott Weiss, MD, an associate professor of pediatrics at Thomas Jefferson University and the division chief of critical care medicine at Nemours Children’s Hospital in Wilmington, Delaware.

Other medications may be given later in certain circumstances, including a proton pump inhibitor for those at risk of developing ulcers because of stress on the body, heparin for those at risk of deep vein thrombosis, and medications to control blood sugar levels.

Antibiotics

Although various organisms can cause an infection that turns into sepsis — such as bacteria, viruses, and fungi — bacteria is by far the most common cause, so the main treatment for sepsis typically is antibiotics.

You’ll receive antibiotics immediately after your doctor diagnoses sepsis, even when test results haven’t yet confirmed a bacterial infection. Ideally, you should receive antibiotics within the first three hours of diagnosis.

Different antibiotics work better with certain types of bacteria. But because it takes time to identify which microbe is causing your infection, you’ll first receive a broad-spectrum antibiotic that can kill several types of bacteria. Later in your treatment, you may receive an antibiotic that’s targeted for the specific bacteria, and you may get an antifungal medication if a fungal infection is possible.

Doctors can treat sepsis with several antibiotics, depending on the cause of the underlying infection and issues such as an antibiotic-resistant infection.

 Most belong to the β-lactam medication class, which are broad-spectrum antibiotics.
Cephalosporins Derived from penicillin, this subclass of β-lactam antibiotics fights bacteria by targeting their cell wall. Examples include the following:

  • cefepime (Maxipime)
  • ceftazidime (Fortaz)
  • ceftriaxone (Rocephin)
Fluoroquinolones In use for around 40 years, this class of antibiotics targets bacteria’s DNA and includes these broad-spectrum examples:

  • ciprofloxacin (Cipro)
  • levofloxacin (Levaquin)
Glycopeptides These broad-spectrum medications are often given to people who are infected with bacteria that’s become resistant to treatment from other antibiotics. The primary antibiotic from this class is vancomycin (Firvanq).

Penicillins The original antibiotic is still in use for people with sepsis. It belongs to the larger β-lactam class and works by blocking bacteria’s ability to synthesize cell walls.

The primary penicillin medication used for sepsis is piperacillin, which is often combined with tazobactam, a related antibiotic (Zosyn is the brand name of this combination).

Macrolides Introduced in 1952, macrolides block bacteria’s protein synthesis. They are especially good at treating respiratory infections that circulate in the community at large, rather than those in a hospital.

Azithromycin (Zithromax) is the primary macrolide used to treat sepsis.

Nitroimidazoles These antibiotics stop bacteria from growing.

 Metronidazole (Flagyl), the main member of this class used for sepsis treatment, is often combined with other antibiotics, particularly for infections related to the skin, soft tissues, and gastrointestinal and abdominal area.

If you have mild sepsis, you may receive a prescription for antibiotics to take at home. But if your condition progresses to severe sepsis, you will receive antibiotics intravenously in the hospital. This method helps the medicine get into your bloodstream quicker so it can fight the infection sooner.

Antiviral Medications

In some cases, a viral infection causes sepsis. If testing confirms this, your doctor may start you on an antiviral medication to help treat the underlying condition.

 Not all viruses have targeted antiviral treatments.

Antifungal Medications

When a fungal infection causes sepsis, you will likely receive an intravenous antifungal drug.

 Fungal infections that can turn into sepsis include a fungal bloodstream infection associated with catheters, a fungal infection in the gastrointestinal tract, a fungal infection in the lungs, and a fungal infection in the brain.

Intravenous Fluids

Even though sepsis is caused by an infection, antibiotics and other antimicrobials may not be enough to maintain a healthy blood pressure.

 Low blood pressure – a reading of 90/60 mmHg or lower for people who typically have normal blood pressure — can occur with severe sepsis and septic shock. To increase your pressure, you’ll need IV fluids while in the hospital.

Fluids help increase blood volume and prevent dehydration, which are two contributing factors to low blood pressure. Symptoms of too low pressure include shallow breathing, rapid pulse, clammy skin, and confusion.

Treating low blood pressure is crucial because in this state, it becomes harder for blood to carry oxygen to different parts of the body. Organ damage can occur when your body doesn’t get enough oxygen.

Various types of intravenous fluids can treat sepsis and increase blood volume. These include crystalloid fluids that contain minerals such as sodium (saline is an example). You may also receive colloids, which are thicker liquids, such as albumin.

Vasopressor

Doctors may use another type of therapy when IV fluids are unable to increase blood pressure. Some people receive vasopressor medications, which constrict blood vessels to forcefully increase blood pressure. Norepinephrine is a first-line vasopressor for sepsis; epinephrine may be given later if needed.

“For septic shock, vasopressors may be administered to maintain blood pressure within a safe range,” says Eleanor Erwin, MD, a board-certified emergency room physician with Williamsburg Emergency Physicians in Virginia. “Other medications may be tailored to the individual patient's other medical problems.”

Corticosteroids

Corticosteroids target the inflammation that may stem from a maladaptive overreaction of your immune system. Medications such as hydrocortisone are sometimes given to people with septic shock who are taking higher doses of vasopressors, as corticosteroids can reduce the dosage of vasopressor that’s needed.

Surgery

Once a doctor determines the source of the infection, surgery may be necessary to remove the infection as well as any infected or damaged tissues. For instance, you may need surgery or a similar treatment if you have an abscess, which is a pocket of pus usually caused by an infection.

An abscess can form on the skin or inside the body as a complication of another infection. Some abscesses respond to antibiotics. But sometimes doctors must make an incision and drain an abscess or surgically remove an abscess to stop an infection.

Other Treatments

You may require other types of supportive therapy based on the extent of your condition. These therapies vary from person to person.

Blood Transfusion

People with sepsis may have a low number of red blood cells (anemia) and may need a blood transfusion while in the hospital. A red blood cell transfusion can be vital to help improve oxygen delivery throughout the body for those with anemia.

Dialysis

As sepsis progresses, kidney damage can occur. If your kidneys stop functioning properly, you’ll need dialysis (also called renal replacement therapy) to help your kidneys filter blood and remove toxins from your body.

Hemodynamic Monitoring

Septic shock can damage different organs, such as your heart and lungs. Your doctor may use hemodynamic monitoring to keep a close eye on your heart and lung function. This machine works by measuring the blood pressure in your veins, heart, and arteries, as well as the amount of oxygen in your blood.

Hyperglycemia Treatment

Some people with severe sepsis and septic shock also experience high blood sugar (hyperglycemia). This risk applies to people with diabetes and those without diabetes. It is believed that a combination of stress and inflammation can induce insulin resistance and higher glucose levels. If so, you’ll usually receive insulin intravenously.

Supplemental Oxygen

Low blood pressure or acute respiratory distress syndrome (a type of respiratory failure in septic shock) may result in not enough oxygen reaching your organs. For that reason, some people with low blood oxygen levels are given extra oxygen.

This therapy helps raise the amount of oxygen the lungs receive and subsequently the amount of oxygen that’s delivered to your blood. There are different ways to receive oxygen therapy, such as through a nasal tube, a face mask, or mechanical ventilation (inserting a tube into the trachea).

Rehabilitation and Therapy

Long-term health issues are common in adults after sepsis. Up to half of those who get sepsis struggle with postsepsis syndrome, which has a myriad of symptoms that include problems sleeping, shortness of breath, muscle pain, and repeated infections. It can also cause depression, memory issues, and even nightmares.

This is also common with kids who get sepsis. “Approximately one-third of children who survive sepsis will continue to struggle after hospital discharge,” says Dr. Weiss. “Common challenges include low physical endurance, decreased attention or ability to focus, anxiety, sleep problems, and emotional lability.”

Your doctor can connect you with resources for ongoing support, such as counselors or physical therapists. “It’s important that families and pediatricians look for even subtle signs of lingering issues and seek help,” says Weiss.

This is also important to prevent future infections. “Properly managing chronic medical problems that can compromise the immune system, such as controlling diabetes or chronic lung disease, is crucial for both avoiding and recovering from a sepsis infection,” says Dr. Erwin.

The Takeaway

  • Sepsis is a serious, potentially life-threatening complication of an infection that requires prompt medical intervention to fight the underlying infection and treat any resulting issues, such as low blood pressure.
  • Broad-spectrum antibiotics are typically the first-line treatment for sepsis and may be followed by targeted antimicrobials, intravenous fluids, vasopressors, or corticosteroids.
  • Other sepsis treatments include surgery to remove infected or damaged tissue, blood transfusion, dialysis, hemodynamic monitoring, hyperglycemia medication, and supplemental oxygen.
  • Up to half of those with sepsis develop postsepsis syndrome, with symptoms such as sleep issues, difficulty breathing, and repeated infections; these require ongoing care.

Additional reporting by Sarah Shelton.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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Amy Walsh

Amy Walsh, MD, MDP

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Amy Walsh, MD, MDP, is a board-certified emergency physician at HealthPartners. She has 15 years of experience, fellowship training in global emergency medicine, and extensive expe...

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