Severe systemic infection unknown source

Duration

Seek advice

First Line

IV Amoxicillin 1g 8 hourly

+ IV Metronidazole 500mg 8 hourly

+ IV Gentamicin3

Penicillin Allergy

IV Vancomycin3

+ IV Metronidazole 500mg 8 hourly

+ IV Gentamicin3

Notes

Give all 3 antibiotics otherwise regimen may not be effective

Possible infective endocarditis

Send 3 sets of blood cultures and seek specialist advice

 

Immediate Management – SEPSIS SIX

1.

OXYGEN

Correct hypoxia—aim for O2 sats 94-98%

(88 – 92% for patients with chronic CO2 retention)

2.

FLUID RESUSCITATION

Start IV fluids—20ml/kg

Minimum 500ml in first hour

3.

LACTATE

Obtain whole blood lactate. Urgent FBC, U+E’s and coagulation

4.

URINE OUTPUT/FLUID BALANCE MEASUREMENT

Consider Urinary Catheter

5.

INFECTION SCREEN

Blood Cultures in all patients. Send additional samples relevant to source of sepsis.

6.

DRUG THERAPY

I.V. Antibiotics (all required antibiotics initiated within 1 hour)

 

Doses may need to be adjusted in renal impairment. Always check BNF for interactions. Seek advice if patient pregnant

Drug specific Interactions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid Doxycycline and Co-trimoxazole if pregnant or breast feeding
  3. Gentamicin/Vancomycin refer to online calculators
  4. ALERT antibiotic needs ALERT form
  5. Monitor sodium
  6. See CURB65 definition
  7. Reference: The Renal Drug Handbook 4th Edition, 2014