Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation

The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophy...

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Published in:Critical care (London, England) England), 2018-10, Vol.22 (1), p.283-7, Article 283
Main Authors: Moskowitz, Ari, Andersen, Lars W, Huang, David T, Berg, Katherine M, Grossestreuer, Anne V, Marik, Paul E, Sherwin, Robert L, Hou, Peter C, Becker, Lance B, Cocchi, Michael N, Doshi, Pratik, Gong, Jonathan, Sen, Ayan, Donnino, Michael W
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - pharmacology
Adrenal Cortex Hormones - therapeutic use
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Ascorbic acid
Ascorbic Acid - pharmacology
Ascorbic Acid - therapeutic use
Corticosteroids
Drug Therapy, Combination - methods
Drug Therapy, Combination - standards
Humans
Hydrocortisone - pharmacology
Hydrocortisone - therapeutic use
Metabolic resuscitation
Models, Biological
Review
Sepsis
Sepsis - drug therapy
Thiamine
Thiamine - pharmacology
Thiamine - therapeutic use
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Summary:The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research for each element of the thiamine, ascorbic acid, and hydrocortisone drug combination in sepsis. In addition, we describe potential areas of synergy between these therapies and discuss the strengths/weaknesses of the two studies to date which have evaluated the drug combination in patients with severe infection. Finally, we describe the current state of current clinical practice as it relates to the thiamine, ascorbic acid, and hydrocortisone combination and present an overview of the randomized, placebo-controlled, multi-center Ascorbic acid, Corticosteroids, and Thiamine in Sepsis (ACTS) trial and other planned/ongoing randomized clinical trials.
ISSN:1364-8535
1466-609X
1364-8535
DOI:10.1186/s13054-018-2217-4