Sepsis remains one of the leading causes of death in intensive care units worldwide. Despite significant progress in early detection and management, antibiotic dosing protocols often fail to account for patient-specific factors, particularly those linked to biological sex and gender-related disparities in care.
A new editorial in the Journal of Intensive Medicine draws attention to this issue, underscoring how biological sex and gender inequities can contribute to suboptimal sepsis treatment and poorer outcomes for women. The article highlights overlooked pharmacokinetic and pharmacodynamic differences between men and women and calls for their systematic integration into antimicrobial dosing strategies.
The authors note that women remain underrepresented in pharmacological research and face a higher risk of antibiotic overexposure. Factors such as hormonal fluctuations, body composition, and renal clearance affect how drugs are metabolised, yet these influences are rarely reflected in standard dosing algorithms. Conversely, men, particularly younger patients with augmented renal clearance, may receive insufficient doses, increasing the risk of treatment failure.
Standard dosing overlooks critical biological differences, the authors explain. Women, due to altered metabolism and lower muscle mass, are more susceptible to adverse drug effects, whereas younger men often eliminate antibiotics too quickly to maintain therapeutic concentrations.
The editorial also points to the role of gender-based disparities in healthcare delivery. Women are less likely to receive prompt or aggressive sepsis interventions, a discrepancy often rooted in symptom misinterpretation, differences in health-seeking behaviour, and implicit bias within emergency and critical care systems.
These biological and gender-related factors intersect to exacerbate inequities in sepsis outcomes. Standardised dosing that ignores these variations may expose women to greater toxicity while leaving men at risk of underdosing, underscoring the need for more individualised antimicrobial management.
To address this, the authors advocate for expanded use of therapeutic drug monitoring to personalise dosing, optimise efficacy, and reduce both toxicity and antimicrobial resistance. They also call for sex- and gender-conscious research frameworks, noting that fewer than one-third of current studies report sex-stratified data.
Recognising and understanding the impact of sex and gender on sepsis treatment is essential to advancing personalised medicine. It is not only a scientific imperative but a matter of equity.
Source: Journal of Intensive Medicine
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