## 1 Introduction  
There are few areas in critical medicine that generate as much interest and research as sepsis. Despite diagnostic and therapeutic advances, sepsis morbidity, mortality, and incidence remain very high. Sepsis is an altered host response to an infectious pathogen, causing potentially life-threatening organ dysfunction, and septic shock is a subset of sepsis in which the underlying circulatory and metabolic abnormalities are deep enough to substantially increase mortality [1]. Despite critical care progress in recent years in critical care, sepsis and septic shock account for more than 50% of deaths in critical care units.  
Sepsis is now recognized as a multifactorial host response to an infectious pathogen that can be significantly amplified by endogenous factors involving the early activation of both pro- and anti-inflammatory responses along with major modifications in non-immunological pathways such as cardiovascular, neuronal, autonomic, hormonal, bioenergetic, metabolic and coagulative [2; 3], all of which are of prognostic importance. Additionally, the biological and clinical heterogeneity of affected individuals is important, as well as age, underlying comorbidities, concurrent injuries (including surgery), medications, and source of infection [1].  
What differentiates sepsis from infection is an aberrant or poorly regulated host response with the presence of organ dysfunction. The severity of organ dysfunction has been evaluated with various scoring systems that quantify abnormalities based on clinical findings, laboratory data, or therapeutic interventions. Differences in these scoring systems have also resulted in inconsistent information. The predominant score currently in use is the Sequential Organ Failure Assessment Score (SOFA), which has been simplified in quick SOFA [1; 3].  
Garlic (_Allium sativum_) has long been a medicinal ingredient used as an antineoplastic and antimicrobial agent. Sulfur compounds (i.e., thiosulfinates) appear to be the active components in the root bulb of the garlic plant [4; 5]. Allicin is the main thiosulfinate of _Allium sativum_ and could act on four points of the inflammatory cascade. The ability of allicin to inhibit the activation of the nuclear factor NF-x\(\upbeta\)[6], prevent the adhesion of T cells to endothelial cells and reduce transendothelial migration [7] have been described. Allicin can also reduce the activity of induced nitric oxide synthase [8] and decrease the amount of nitric oxide and the vasodilation that may lead to shock. Additionally, it could act by preventing the activation of the coagulation cascade by acting as an antiplatelet [9].  
Up to now, there are no studies that have shown a decrease in morbidity and mortality in the context of sepsis and septic shock, except for antibiotic therapy and the objective-guided resuscitation strategy proposed in the 2016 sepsis campaign. This strategy was made by a group of international experts who established a series of based-on-evidence recommendations for the management of acute sepsis and septic shock. It is also the basis for the better outcome of high-mortality critically ill patients [10]. However, many drugs have been used unsuccessfully in both animal models and clinical trials [11; 12; 13; 14; 15], so there is still a need of new therapeutics that can overcome the antibiotic resistance.  
As allicin is not stable [16], here, we decided to explore whether intraperitoneal applications of thiosulfinate-enriched _Allium sativum_ extract (TASE) could be an adjuvant to specific antibiotic treatment in sepsis and septic shock and to evaluate its possible immunomodulatory role.