Sepsis: Approach and Empiric Tx

End-organ-damage OR hypotension, PLUS fever, tachycardia, tachypnoea, WCC++

Overall Approach
1. CULTURES first. Two bloods. Urine, sputum, wounds as appropriate.
2. Antibiotics
3. Start fluid resus. NS 300ml iv bolus if poor peripheral circulation, confusion, oliguria OR lactate>4mmol/l.
4. Correct Hypotension with target >90/65. Fluid resus then consider Noradrenaline or dopamine infusion.
5. Maintain O2 and glucose.
6. Consider corticosteroids if unresponsive to fluids and vasopressors.
7. Tx according to culture results and choose abx appropriately.
8. If fever persists for >4 days, seek ID Consultant.

Unknown source.
Adults: Flucloxacillin 2g iv qid + Gentamicin 7mg/kg iv stat.
Febrile, Neutropenic: Piperacillin+Tazobactam 4+0.5g iv tid (Tazosin). Add vancomycin if in shock, has MRSA, or high MRSA incidence in ward.

Child, Meningitis Not Excluded (Playing it very safe!)
Over 6 months, Cefotaxime 50mg/kg iv qid.
Under 6 months, add Amoxycillin 50mg/kg iv qid PLUS Vancomycin 30mg/kg iv bd infused.

GIT source?
Metronidazole 500mg iv bd, Amoxicillin 1g iv qid, Gentamicin 6mg/kg*.
Beyond 3 days, stop all above, use Piperacillin+Tazobactam 4+0.5g iv tid (Tazosin).

Intravascular Device?
Flucloxacillin 2g iv qid PLUS Gentamicin 7mg/kg*
MRSA likely, replace fluclox with Vancomycin 1.5g iv bd inf.


*see post on gentamicin dosing.