Page 38 - HPP ANTIMICROBIAL GUIDELINE 2018

Sepsis with persistent hypotension

YES NO

Has patient had? 1. Evaluate whether urgent antibiotic therapy is indicated

1. Previous isolation of MDRO 2. If isolated fever, consider withholding empirical antibiotics
2. Or recurrent hospital admissions past 3 months pending further investigations / microbiology results.

3. Or recent treatment with broad spectrum antibiotics: 3. Regularly reassess the patient.

( eg: Amoxicillin/clavulanate, cefuroxime, piperacillin/tazobactam,
ceftriaxone, ciprofloxacin) May consider:

IV amoxicillin/clavulanate 1.2 gm q8h
OR
IV ceftriaxone 2 gm q24h (if used oral or IV amoxicillin/clavulanate before)

YES NO

IV meropenem 1 gm q8h/ IV Imipenem/cilastatin 500 mg q6h IV piperacillin/tazobactam 4.5 gm q6h

PLUS OR
IV vancomycin (History of MRSA colonization) IV cefepime 1-2gm q8-12h
Review cultures and other investigations by 48 H to attempt de-escalation Review cultures and other investigations by 48 H to attempt de-
therapy with targeted therapy or organ specific therapy escalation therapy with targeted therapy or organ specific therapy

Neutropenic sepsis – please refer chapter on infection in immunocompromised patients.

HPP AMG Sepsis 14