Corticosteroids in sepsis: a new concept for an old drug.

Sepsis is an inflammatory syndrome caused by infection. Consequently, anti-inflammatory therapy in sepsis has been a subject of extensive research, and corticosteroids have long been used to treat severe infections. However, studies conducted in the 1980s failed to demonstrate any beneficial effects of high dose, short-term steroid therapy in sepsis and this therapy was therefore abandoned in the last decade. Recently, a new concept has emerged with more promising results--low dose, long-term hydrocortisone therapy- and this approach is now being evaluated in the treatment of septic shock. It is supported by the observation that many sepsis patients have relative adrenal insufficiency. Moreover, the anti-inflammatory effects of steroids and their ability to improve reactivity to catecholamines further contribute to their effects in sepsis. Large randomized clinical trials will be required to determine the exact role of corticosteroids in septic shock.