TITLE:
Beyond Antibiotics: A Practical Guide to Host-Directed Therapy in Severe Infections
AUTHORS:
Waleed Amasaib Ahmed, Dalia M. Qutub, Osama Jamaan Mohammed Alzahrani, Hanin Hussain Alsharif
KEYWORDS:
Sepsis, Glycemic Control, Clinical Nutrition, Host-Directed Therapy, Critical Care, Rehabilitation
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.17 No.9,
September
18,
2026
ABSTRACT: Background: While antimicrobial therapy and source control are the pillars of infectious disease management, host factors significantly influence outcomes. Metabolic derangements, malnutrition, and immune dysregulation contribute to treatment failure and prolonged recovery in patients with severe infections such as sepsis, necrotizing soft tissue infections, and diabetic foot infections. Objective: To provide a practical, evidence-based review of non-antimicrobial interventions—specifically glycemic control, nutritional support, immunomodulation, and early rehabilitation—that optimize host resilience. Methods: We reviewed current guidelines and key randomized controlled trials published between 2010 and 2026 regarding adjunctive care in severe infections. Results: Moderate glycemic control (140 - 180 mg/dL) with attention to glycemic variability is superior to intensive control, reducing hypoglycemia without compromising immune function. Early enteral nutrition is preferred over parenteral routes, with a focus on phase-appropriate protein supplementation. Adjunctive corticosteroids benefit specific subsets, such as patients with refractory septic shock or severe community-acquired pneumonia. Early mobilization and delirium prevention strategies significantly reduce long-term disability. Conclusion: Integrating these “host-directed” interventions into a standardized care bundle can improve clinical outcomes. Clinicians should adopt a multidisciplinary approach that treats the patient’s metabolic and functional status with the same urgency as the infection itself.