Canterbury DHB

Context

Sepsis

Sepsis is a medical emergency.

See Sepsis in Adults and Immunosuppressed Patients in Hospital HealthPathways.

Pathogens

Drug treatment

Non-immunosuppressed sepsis without apparent source

If there are risk factors for immunosuppression, see immunosuppressed sepsis without apparent source.

Non-immunosuppressed sepsis without apparent source is divided into three sections:

Community-acquired

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every 24 hours

 

If patient has hypotension and/or new organ dysfunction (two options based on CrCl):

CrCl ≥ 20 mL/min, ADD:

gentamicin

HMLSchedNZFPMLnoids

Single dose of IV 7 mg/kg ideal body weight. Round dose down to nearest half vial (40 mg). Consult Infectious Diseases/Clinical Microbiology before giving a second dose. See dosing/monitoring guidelines.

 

OR

CrCl < 20 mL, use monotherapy of:

piperacillin+tazobactam

HMLNZFPMLnoids

IV 4 g/500 mg every twelve hours

 

Severe penicillin allergy

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

Healthcare-associated

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every 24 hours

 

If patient has hypotension and/or new organ dysfunction (two options based on CrCl):

CrCl ≥ 20 mL/min, ADD:

gentamicin

HMLSchedNZFPMLnoids

Single dose of IV 7 mg/kg ideal body weight. Round dose down to nearest half vial (40 mg). Consult Infectious Diseases/Clinical Microbiology before giving a second dose. See dosing/monitoring guidelines.

 

OR

CrCl < 20 mL, use monotherapy of:

piperacillin+tazobactam

HMLNZFPMLnoids

IV 4 g/500 mg every twelve hours

 

Severe penicillin allergy

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

ESBL-colonised in past 12 months

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

Immunosuppressed sepsis without apparent source

If there are no risk factors for immunosuppression, see non-immunosuppressed sepsis without apparent source.

If ESBL-colonised in past 12 months, see separate guideline.

piperacillin+tazobactam

HMLNZFPMLnoids

IV 4 g/500 mg every six hours

 

If patient has hypotension and/or new organ dysfunction, ADD:

gentamicin

HMLSchedNZFPMLnoids

CrCl ≥ 20 mL/min:
Single dose of 7 mg/kg ideal body weight IV. Round dose down to nearest half vial (40 mg). Consult Infectious Diseases/Clinical Microbiology before giving a second dose. See dosing/monitoring guidelines.
 

CrCl < 20 mL/min:
Not recommended.

 

Mild penicillin allergy

cefepime

HMLNZFPMLnoids

IV 2 g every eight hours

 

If patient has hypotension and/or new organ dysfunction, ADD:

gentamicin

HMLSchedNZFPMLnoids

CrCl ≥ 20 mL/min:
Single dose of 7 mg/kg ideal body weight IV. Round dose down to nearest half vial (40 mg). Consult Infectious Diseases/Clinical Microbiology before giving a second dose. See dosing/monitoring guidelines.
 

CrCl < 20 mL/min:
Not recommended.

 

Severe penicillin allergy

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

Information about this Canterbury DHB document (99250):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

May 2022 (Sepsis)

Next Review Due:

May 2025

Keywords:

sepsis, immunosuppressed

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 99250