Clinical definition:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is sepsis that requires vasopressor therapy to maintain blood pressure. The choice of empiric antibiotic(s) will depend on the likely source of infection (see individual infections). The guidance given here relates to sepsis and septic shock where no infection source is immediately identifiable.
| Preferred antibiotic choice(s) when no source is identified and/or is community-acquired with low risk of drug-resistant bacteria | |||
| Drug | Formulation | Dosage | Duration |
| Combination therapy with: Ampicillin (IV) OR Amoxicillin-clavulanic acid (IV) PLUS Gentamicin (IV) | Ampicillin- Powder for injection: 500 mg; 1 g (as sodium salt) in vial | 200 mg/kg 4 hourly | 10 days |
| Amoxicillin-clavulanic acid- Powder for injection: 500 mg (as sodium) + 100 mg (as potassium salt); 1000 mg (as sodium) + 200 mg (as potassium salt) in vial | 1 g amoxicillin component 8 hourly | 10 days | |
| Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/ mL in 2- mL vial. | 2 mg/kg 12 hourly | 5 days | |
| Alternative antibiotic choice(s) | |||
| Combination therapy with; Ceftriaxone (IV) PLUS Gentamicin (IV) | Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial | 2 g daily | 10 days |
| Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/mL in 2-mL vial. | 2 mg/kg 12 hourly | 5 days | |
| Preferred antibiotic choice(s) when no source is identified and is hospital-acquired with high risk of drug-resistant bacteria | |||
| Drug | Formulation1 | Dosage | Duration |
| Combination therapy with Piperacillin-tazobactam (IV) PLUS Amikacin (IV) | Piperacillin-tazobactam- Powder for injection: 2 g (as sodium salt) + 250 mg (as sodium salt); 4 g (as sodium salt) + 500 mg (as sodium salt) in vial | 4.5 g 6 hourly | 10 days |
| Amikacin – Injection: 250 mg (as sulfate)/mL in 2-mL vial | 15 mg/kg daily | 5 days | |
Principles of Stewardship:
- If the primary source of sepsis is defined, amend treatment duration according to the suggested duration for individual infections.
Notes:
- Early administration of broad-spectrum antibiotics is critical in patients presenting with sepsis.
- Amikacin has better coverage for extended-spectrum betalactamase than gentamicin.