An Example of Initial Antibiotic Therapy Regime for Adult Sepsis (Excludes Penicillin Allergic Patients). Always Seek Local Guidance and Check Doses in the British National Formulary
| Suspected source of sepsis | Initial antibiotic therapy (IV, high dose if septic shock) |
|---|---|
| Bacterial meningitis | Ceftriaxone 4g IV as a single dose on day 1, then 2g IV OD thereafter. If immunocompromised or age >60y consider amoxicillin 2g IV q 4-hourly to cover listeria |
| Community-acquired pneumonia | Severe (CURB 65 ≥2): co-amoxiclav 1.2g IV tds, plus doxycycline 200 mg PO OD |
| Hospital-acquired pneumonia | Co-amoxiclav 1.2g IV tds, plus gentamicin 5 mg/kg IV (if late >3 days after admission) |
| Infective endocarditis | Take 3 sets of cultures, ideally 2–4 hours apart. Discuss with Infection prior to starting antibiotics see Table 52.7 P. 336 |
| Urinary tract infection | Complicated/healthcare associated/pyelonephritis: co-amoxiclav 1g IV tds |
| Intra-abdominal sepsis, for example appendicitis, peritonitis. Seek advice for other conditons, for example spontaneous bacterial peritonitis. | Cefuroxime 1.5g IV tds plus metronidazole 500 mg IV tds |
| Suspected vascular catheter related bloodstream infection | Vancomycin IV plus gentamicin 5 mg/kg IV |
Septic arthritis (native joint) Seek advice for prosthetic joint or metalwork infection | Flucloxacillin 2g IV qds |
| Cellulitis | Flucloxacillin 2g IV qds |
Necrotizing fasciitis Discuss urgently with Infection/plastic surgeon | Cefuroxime 1.5g IV tds plus gentamicin 5 mg/kg IV plus metronidazole 500 mg IV tds |
| No localizing signs: neutropenic | Meropenem 1g IV tds |
| No localizing signs: not neutropenic | Community associated: cefuroxime 1.5g IV tds plus gentamicin 5 mg/kg IV plus metronidazole 500 mg IV tds Healthcare associated: co-amoxiclav 1.2g IV tds plus gentamicin 5 mg/kg IV |