Sepsis of Unknown Origin

Micro-organism

Blood stream infection/septicaemia

Duration

Example: Total IV/PO 7-10days

First Line

 IV Amoxicillin 500mg three times daily + IV Metronidazole 500mg three times daily + IV Gentamicin (see guideline for dosing)

If MRSA considered add IV Vancomycin to regimens

Second Line Allergy

Vancomycin IV    +

Gentamicin IV  +

Metronidazole 500mg TID

Severe sepsis of unknown origin/Septic shock

IV Piperacillin/Tazocin 4.5g 6 Hourly + IV Gentamicin

Severe sepsis of unknown origin/Septic shock - 1st Line

IV Piperacillin/Tazobactam 4.5g Three times daily +

IV Gentamicin

Review daily (can be reduced to 8 hourly with clinical improvement) If MRSA considered add IV Vancomycin to regimens

Second Line alternative Anaphylaxis allergy

Vancomycin iv + Gentamicin IV + Ciprofloxacin IV 400mg 12 hourly Metronidazole IV 500mg 8 hOURLY

Discuss with consultant immediately

Severe Sepsis unknown origin/Septic shock - Anaphlaxis allergy

IV Vancomycin +

IV Gentamicin +

IV Ciprofloxacin 300mg 12 hourly +

IV Metronodazole 500mg 8 hourly

Discuss with consultant immediately

Neutropenic Sepsis

Standard risk ; Piperacillin/tazobactam iv 4.5g 6 hourly High risk add Gentamicin IV 2nd line Vancomycin IV + Ciprofloxacin 400mg 12 hourly High risk add Vancomycin IV

Consider recent admissions to hospitals and foreign travel eg . risk of MRSA/Malaria If MRSA considered possible add Vancomycin IV to regimens

Neutropenic sepsis (see handbook for definitions) - Standard risk 1st line

IV Piperacillin/Tazocin 4.5g 6 hourly 

For high risk as above + IV Gentamicin

If MRSA considered add IV Vancomycin to regimens

Neutropenic sepsis (see handbook for definitions) - Standard risk 2nd line

IV Vancomycin +

IV Ciprofloxacin 12 hourly

For high risk add IV Gentamicin

If MRSA considered add IV Vancomycin to regimens

Notes

Consider recent hospital admissions and foreign travel.

Travel eg risk of MRSA/Malaria