Two Drugs Found Equal in Treatment of Septic Shock

By Ed Edelson
HealthDay Reporter
Wednesday, February 27, 2008; 5:04 PM

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WEDNESDAY, Feb. 27 (HealthDay News) -- The artery-tightening medication vasopressin holds no overall advantage over an older drug, norepinephrine, in the treatment of severe septic shock, a new study finds.

But vasopressin did appear to be better for less severe cases in the study, said Dr. James. A Russell, a professor of medicine at the University of British Columbia and lead author of a report in the Feb. 28 issue of the New England Journal of Medicine.

Septic shock occurs when an infection, usually bacterial, overwhelms the body's natural defenses, causing drastic drops in blood pressure and blood flow. Quick treatment to raise blood pressure can reduce the death rate, which is high. In this study, more than 35 percent of those treated with either drug died in the first four weeks.

"Vasopressin has been widely used for the treatment of septic shock because of studies showing an improvement in blood pressure and function," Russell said. "There has never been a large study examining the effect on mortality. Our study showed that basically, vasopressin and norepinephrine are safe and equally effective overall."

The study included 778 people treated for septic shock in a number of hospitals in Canada, Australia and the United States. In the first 28 days, 35.4 percent of those given vasopressin and 39.3 percent of those treated with norepinephrine died -- a difference that was not statistically significant.

But there was a statistically significant difference among those with less severe septic shock, defined by the dose of norepinephrine needed to raise blood pressure the desired amount, Russell said. In that group -- about half the people in the study -- 26.5 percent of those given vasopressin died, compared to 35.7 percent of those given norepinephrine. The death rate for more severe cases was 44 percent with vasopressin treatment, 42.5 percent with norepinephrine treatment.

"In our hospital, patients with less severe septic shock are being treated with vasopressin," Russell said.