New editorial urges clinicians to address sex-based disparities in sepsis treatment
The editorial highlights biological and gender-driven disparities shaping antibiotic dosing, therapeutic effectiveness, and outcomes in sepsis treatment
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Optimal antibiotic therapy demands careful drug selection, precise dosing strategies, and elimination of sex- and gender-based dosing biases.
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Sepsis continues to be a leading cause of mortality in ICUs worldwide. Despite advances in early detection and treatment, standardized antibiotic dosing frequently ignores patient-level variability—especially that associated with sex-related physiology and gender-influenced care disparities.
A newly published editorial in the Journal of Intensive Medicine on September 8, 2025, is calling attention to how biological sex and gender inequities contribute to suboptimal sepsis treatment, potentially compromising outcomes for women. Authored by Dr. Helena Barrasa, Dr. Goiatz Balziskueta, and Prof. Jordi Rello, the piece highlights overlooked pharmacokinetic and pharmacodynamic differences between men and women, and urges the integration of sex and gender into antimicrobial dosing protocols.
The editorial emphasizes that women often face both underrepresentation in pharmacological trials and higher risks of antibiotic overexposure. Hormonal fluctuations, body composition, and renal clearance all influence how drugs are processed, yet these variables are rarely considered in dosing algorithms. Meanwhile, men—especially younger individuals with augmented renal clearance—may be underdosed, leading to treatment failure.
"Standard dosing overlooks key biological differences," said the authors. "Women, due to altered metabolism and lower muscle mass, are more vulnerable to adverse effects, while young men often eliminate drugs too quickly to maintain therapeutic levels."
Beyond biology, gender roles and biases further complicate sepsis care. Women are less likely than men to receive aggressive or timely interventions, with disparities stemming from symptom misinterpretation, healthcare-seeking behaviors, or implicit bias within emergency systems.
These inequities compound the biological differences already influencing pharmacokinetics and pharmacodynamics. Standardized dosing often overlooks how women are more prone to antibiotic overexposure and adverse reactions, while younger men with augmented renal clearance face underdosing and treatment failure. Such imbalances highlight the urgency of tailoring antimicrobial therapy more precisely.
The authors advocate for wider use of therapeutic drug monitoring to individualize treatment and reduce both toxicity and resistance. They also call on the scientific community to integrate sex- and gender-aware research protocols, noting that fewer than 30% of studies currently report sex-stratified data.
In conclusion, Prof. Rello stated, "Understanding the differences shaped by sex and gender is essential to advancing personalized medicine and represents a commitment to reducing the equity gap."
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Reference
DOI: 10.1016/j.jointm.2025.08.004
About Vall d'Hebron University Hospital, Barcelona, Spain
The Vall d’Hebron University Hospital, founded in 1952, is one of the largest hospitals in Spain. It is comprised of four large centers: the General Area, the Maternity and Children’s Area, the Orthopaedics and Rehabilitation Area, and the Outpatient Surgery which cover almost all medical and surgical specialties. The hospital has an excellent oncology department and palliative care unit. The hospital also focuses on research-based innovations and actively runs clinical trials. The institution also conducts training for health-care professionals on a regular basis.
Website: https://www.vallhebron.com/en
About Professor Jordi Rello from Vall d'Hebron University Hospital, Barcelona, Spain
Jordi Rello is Professor of Medicine at the Universitat Internacional de Catalunya and Senior Consultant of Critical Care at the Vall d'Hebron University Hospital in Barcelona, Spain. He earned his PhD in Infectious Diseases at the University of Barcelona, Spain. His areas of research include studies on prevention and control of hospital-acquired infections, epidemiology of ventilator-associated pneumonia, gender medicine and treatment of infections in critically ill patients. He has authored 750+ research articles. He is also the Director of the Clinical Research & Innovation in Pneumonia and Sepsis (CRISP) Group at Vall d'Hebron Institute of Research.
Funding information
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Journal
Journal of Intensive Medicine
Method of Research
Commentary/editorial
Subject of Research
People
Article Title
Sex-related differences in antimicrobial dosing for sepsis: Bridging the equity gap
Obesity treatment risks becoming a ‘two-tier system’, researchers warn
Treatment for obesity in the UK could become a “two-tier system” where the most vulnerable patients miss out altogether.
Obesity experts from King’s College London and the Obesity Management Collaborative (OMC-UK) have warned that strict eligibility criteria means that only a small number of people will have access to the weight loss drug Mounjaro on the NHS. With those able to afford it paying privately for treatment.
The researchers argue, in an editorial published today in the British Journal of General Practice (BJGP), that this gap creates a two-tier treatment system, where the ability to self-fund determines who receives care.
Obesity is a global health crisis linked to serious conditions such as heart disease, type 2 diabetes and cancer. The NHS’s phased rollout of tirzepatide, also known as Mounjaro, has been welcomed as an important step in tackling the problem.
Recent data suggests that more than one and a half million people in the UK are accessing these new medications privately. By contrast, NHS provision is expected to reach only around 200,000 patients in the first three years.
The current NHS criteria for access to Mounjaro require patients to have a BMI of 40 or above combined with several additional health conditions such as diabetes, high blood pressure or heart disease. While this approach does provide some access to effective obesity treatment, it excludes many people who are at serious risk but do not meet all of these requirements.
The researchers warn that these rules risk widening existing health inequalities.
Lead author Dr Laurence Dobbie NIHR Academic Clinical Fellow in General Practice at King’s College London said:
“The planned rollout of Mounjaro risks creating a two-tier system in obesity treatment. Unless we adjust how eligibility is defined and how services are delivered, the planned roll-out of Mounjaro risks worsening health inequalities, where ability to self-fund determines access to treatment and those with the greatest need are less likely to qualify for treatment.
“Current eligibility criteria require multiple diagnosed qualifying criteria, yet the very conditions used to gatekeep access to Mounjaro are frequently under-diagnosed in women, people from minority ethnic communities, those from low income and patients with severe mental illness. The under-diagnosis is well-documented and regional variation in NHS commissioning creates a postcode lottery.
“We should recognise under-diagnosis explicitly in obesity pathways, prioritise our patients at the highest clinical need, and scale culturally adapted wrap-around support so access is based on need, not means or location.”
Professor Barbara McGowan, Professor in Endocrinology and Diabetes at King’s College London, said:
“Obesity is a complex, chronic disease that demands equitable access to treatment for all who need it — not just those who can afford it. The current approach risks entrenching a two-tier system where wealth, rather than medical need, determines access to care. We urgently need a more inclusive, fair and scalable model that ensures effective treatments are accessible across all communities, especially those already facing systemic barriers to healthcare."
Professor Mariam Molokhia, Professor in Epidemiology and Primary Care at King’s College London says:
“Obesity care should not depend on postcode or the ability to self-fund. Current criteria risk excluding high-need patients because qualifying conditions are often under-diagnosed in the very groups who face the greatest barriers to care. For equitable delivery of care it is important to: recognise under-diagnosis in eligibility criteria, prioritise severe obesity and those with the highest clinical needs, and provide culturally adapted behavioural support.”
The opinion piece calls for changes to improve fairness and equity. These include changing who qualifies for support, setting up clearer routes to accessing care that take ethnicity and under-diagnosis into account, accelerating the national rollout, and expanding digital health services to reach patients in areas where specialist services are limited.
The authors also stress that access to medication must go hand-in-hand with broader public health measures, including policies to improve diets, address food insecurity and ensure healthier urban environments.
The researchers conclude that without urgent changes to policy, inequalities in obesity care will persist and worsen for future generations.
Journal
British Journal of General Practice
Manifestations of structural racism and inequities in cardiovascular health across US neighborhoods
JAMA Health Forum
About The Study: In this cross-sectional study, structural racism was associated with inequities in neighborhood cardiovascular health, highlighting opportunities for place-based prevention efforts.
Corresponding Author: To contact the corresponding author, Wayne R. Lawrence, DrPH, MPH, email wayne.lawrence@nih.gov.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamahealthforum.2025.3864)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2025.3864?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=103125
Journal
JAMA Health Forum
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