Treatment of endotoxic shock: Glucocorticoids, lazaroids, nonsteroidals, others

Endotoxemia and septicemia are important clinical syndromes in companion animals, humans, and other species. They occur secondary to a variety of conditions. Endotoxin mediates its toxic effects through interactions with receptors on the surface of host endothelial cells, macrophages/monocytes, and polymorphonuclear leukocytes that result in the production and release of numerous biochemical mediators. These mediators include cytokines, nitric oxide, eicosanoids, platelet activating factor, and others. This article focuses on several agents that may prove useful in treating the patient with endotoxic shock and include: glucocorticoids, lazaroids, nonsteroidals, pentoxifulline, and nitric oxide inhibitors. Unfortunately, no one therapy is likely to provide the "magic bullet" for the patient in endotoxic shock, thus treatment may ultimately involve combination therapy using some of the drugs discussed in this article that target different pathways and mediators.