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- W3092508723 abstract "We disagree with the assertion by 1) that a randomized placebo-controlled trial of protein C in meningococcal septicaemia would be impossible to perform. A large randomized study of the anti-lipopolysaccharide antibody HA1A was carried out between 1991 and 1995 and recruitment to a large multicentre study of rBPI in severe meningococcaemia is currently nearing completion. There is no question that such studies pose great logistic and ethical challenges. However, it would be unethical to embark upon general use of a new adjunctive treatment based on anecdotal experience alone, however compelling. Untested treatments may have unforeseen and significant adverse effects (for example another recent study showed unexpected untoward effects of two anticoagulants used together (2)), can be very expensive, and may simply not work. Furthermore, as other treatments are developed, the safety and effectiveness of different combinations cannot be undertaken without a secure knowledge base. We currently have very little understanding of whether the endothelial mechanisms required to activate protein C are intact in meningococcal disease. Without some information about this it is impossible to make a choice as to whether we should be assessing native protein C or the activated form for therapy. Furthermore, a trial cannot be designed until we have more data on the kinetics of protein C. We agree with the final assertion of 1) that the coordination of studies should be improved. It is only by large-scale collaboration that we can progress. A network which will aim to include all the units providing intensive care to children and young people in the United Kingdom is now being planned, and, as the Republic of Ireland is afflicted with a similarly high incidence, centres there may wish to participate as well. Its aims will be to facilitate all multicentre clinical studies of the epidemiology, pathophysiology, treatment and prevention of this infection." @default.
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- W3092508723 date "1999-07-01" @default.
- W3092508723 modified "2023-09-24" @default.
- W3092508723 title "INFECTIOUS PURPURA FULMINANS: CAUTION NEEDED IN THE USE OF PROTEIN C" @default.
- W3092508723 cites W2015110474 @default.
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- W3092508723 doi "https://doi.org/10.1046/j.1365-2141.1999.1561a.x" @default.
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