The Center For Disease Dynamics, Economics & Policy

Sepsis (Septicemia) & Septic Shock

Clinical definition:

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is sepsis that requires vasopressor therapy to maintain blood pressure. The choice of empiric antibiotic(s) will depend on the likely source of infection (see individual infections). The guidance given here, relates to sepsis/septic shock where no infection source is immediately identifiable.

 

Preferred antibiotic choice(s) when no source is identified and/or is community-acquired with low risk of drug-resistant bacteria
Drug Formulation Dosage Duration
Combination therapy with:

Ampicillin (IV)

OR

Amoxicillin-clavulanic acid (IV)

PLUS

Gentamicin (IV)

Ampicillin- Powder for injection: 500 mg; 1 g (as sodium salt) in vial 200 mg/kg 4 hourly 10 days
Amoxicillin-clavulanic acid- Powder for injection: 500 mg (as sodium) + 100 mg (as potassium salt); 1000 mg (as sodium) + 200 mg (as potassium salt) in vial 1 g amoxicillin component 8 hourly 10 days
Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/ mL in 2- mL vial. 2 mg/kg 12 hourly 5 days
Alternative antibiotic choice(s)
Combination therapy with;

Ceftriaxone (IV)

PLUS

Gentamicin (IV)

Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial 2 g daily 10 days
Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/mL in 2-mL vial. 2 mg/kg 12 hourly 5 days
Preferred antibiotic choice(s) when no source is identified and is hospital-acquired with high risk of drug-resistant bacteria
Drug Formulation1 Dosage Duration
Combination therapy with

Piperacillin-tazobactam (IV)

PLUS

Amikacin (IV)

Piperacillin-tazobactam- Powder for injection: 2 g (as sodium salt) + 250 mg (as sodium salt); 4 g (as sodium salt) + 500 mg (as sodium salt) in vial 4.5 g 6 hourly 10 days
Amikacin – Injection: 250 mg (as sulfate)/mL in 2-mL vial 15 mg/kg daily 5 days

 

Principles of Stewardship:

  • If the primary source of sepsis is defined, amend treatment duration according to the suggested duration for individual infections.

Notes:

  • Early administration of broad-spectrum antibiotics is critical in patients presenting with sepsis.
  • Amikacin has better coverage for extended-spectrum betalactamase than gentamicin.