Introduction: Sepsis is a global health threat with high associated mortality especially among the elderly. Population aging and sepsis have a tremendous negative impact on national health systems worldwide. Biomarkers have been used to guide early diagnosis and treatment. Antibiotics have been the cornerstone for the treatment of sepsis while immune modulatory therapies, except hydrocortisone, have gained a lot of attention lately. This review attempts to give a fully detailed summary of the advancements in the pharmacological management of sepsis in the elderly.
Areas covered: The authors conducted a systematic literature search in the PubMed database using the keywords 'sepsis in the elderly,' 'sepsis and biomarkers,' 'sepsis and antibiotics,' 'sepsis and renal dysfunction,' 'sepsis and hydrocortisone' for articles published only in English language from 2017 up to 2022. The search was restricted to clinical trials and meta-analyses covering the population of interest.
Expert opinion: Despite the authorization of several novel antibiotic regimens targeting multidrug-resistant pathogens, mortality remains high. Adjunctive precision immunotherapy treatment is a new era of research which recently attracts much attention. Combination of antibiotics with precision immunotherapy in an individualized pattern may be the key for decreasing mortality and improve outcomes.
Keywords: Sepsis; antimicrobial resistance; elderly; novel antibiotics; personalized immunotherapy.