Meningococcal disease as a model to evaluate novel anti-sepsis strategies.

OBJECTIVE

To consider the appropriateness of meningococcemia as a clinical entity for the evaluation of anti-endotoxin agents.

DATA SOURCES: English language published literature concerning meningococcemia, sepsis, and endotoxin.

STUDY SELECTION: The purpose of this work is to consider some of the practical and scientific issues that arise in designing clinical trials to evaluate anti-endotoxin agents. A selected review of recently published articles was undertaken.

DATA EXTRACTION AND SYNTHESIS: Relevant literature has been cited to support factual statements in the text.

CONCLUSION

Meningococcemia as a paradigm of endotoxin-mediated Gram-negative sepsis has many advantages. It is a homogeneous population, and it represents a single, measurable, bacterial target that is unequivocally implicated in the pathogenesis of the disease. However, it is an uncommon disease that may develop so quickly that attempts to intervene may be too late to have an effect. There is considerable morbidity, but how best to measure the outcome and the extent to which the results can be extrapolated to adult populations with sepsis secondary to nosocomial infection remain unclear.