This feature outlines the pathophysiology of sepsis and its clinical progression to severe sepsis, septic shock and multiple organ dysfunction syndrome, pointing out that the condition is a severe health and financial burden, as well as forming a significant unmet clinical need. The main treatment approaches that have been taken are treatment of the underlying infection, haemodynamic and respiratory resuscitation, and modulation of the host response. Most of the developmental effort has focused on the latter, although only one approved product, Eli Lilly's Xigris#174; (drotrecogin alpha) has resulted. Other therapies in development, the targets that they involve, and the companies and deals concerned, are examined.