Page 39 - HPP ANTIMICROBIAL GUIDELINE 2018
P. 39

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
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