Sepsis (Septicemia) & Septic Shock

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
Combination therapy with:

Ampicillin (IV)


Amoxicillin-clavulanic acid (IV)


Gentamicin (IV)

Ampicillin- Powder for injection: 500 mg; 1 g (as sodium salt) in vial200 mg/kg 4 hourly10 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 vial1 g amoxicillin component 8 hourly10 days
Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/ mL in 2- mL vial.2 mg/kg 12 hourly5 days
Alternative antibiotic choice(s)
Combination therapy with;

Ceftriaxone (IV)


Gentamicin (IV)

Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial2 g daily10 days
Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/mL in 2-mL vial.2 mg/kg 12 hourly5 days
Preferred antibiotic choice(s) when no source is identified and is hospital-acquired with high risk of drug-resistant bacteria
Combination therapy with

Piperacillin-tazobactam (IV)


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 vial4.5 g 6 hourly10 days
Amikacin – Injection: 250 mg (as sulfate)/mL in 2-mL vial15 mg/kg daily5 days


Principles of Stewardship:

  • If the primary source of sepsis is defined, amend treatment duration according to the suggested duration for individual infections.


  • Early administration of broad-spectrum antibiotics is critical in patients presenting with sepsis.
  • Amikacin has better coverage for extended-spectrum betalactamase than gentamicin.