Sepsis

Clinicians are reminded of the following advice

 

Indication

Empirical Policy

Intra-abdominal sepsis

(i.e. peritonitis, biliary infection)

Amoxicillin + Metronidazole + Gentamacin  -  - IV Co-amoxiclav is a suitable alternative to minimise gentamicin toxicity if ongoing IV therapy required e.g. >3 days

Co-amoxiclav has similar spectrum of cover to pip/taz for IAI/biliary pathogens. If known Co-amoxiclav resistance from previous culture results – discuss options with consultant microbiologist

HAP >5 days since admission +/- risk factors

Co-amoxiclav + Gentamicin –

-it is common practice on wards to escalate patient to pip/taz when felt there is clinical failure despite co-amoxiclav therapy for HAP. Reasonable alternatives to pip/taz in this situation would be as follows:

-clinically not responding to co-amoxiclav but reasonably haemodynamically stable:

PO co-trimoxazole or PO ciprofloxacin

- clinical failure with sepsis/unwell patient:

IV temocillin +/- vancomycin