Use of antibiotics in septic patients:

There are a multitude of steps for the treatment of sepsis all of which are important for the survival of the patient. One of these crucial steps is the implementation of antibiotic medications. Patients who present with sepsis, septic shock or signs of sepsis need some form of antibiotic therapy and the medications used are usually a set guidelines provided by the local institution. Often times the organism involved is not identified so empiric antibiotics are often the initial management. It is important to emphasize that blood cultures need to be obtained before starting antibiotic therapy.

The criteria described below is based on patients with no signs of sepsis (hypotension, no elevated lactate, or organ dysfunction) and in patients without compromised immune systems:

• Extended-generation cephalosporin
  • Ceftriaxone 2g q24, or
  • Ceftazidime 2g q8, or
  • Cefepime 2g q12

Or

• Piperacillin-tazobactam 3.375g q6

Patients with immune suppression and when pseudomonal organisms are indicated the following are recommended:

• Ceftazidime 2g q8, or
• Cefepime 2g q8

Or

• Piperacillin-tazobactam 4.5g (dose higher for pseudomonal coverage)

Or

• Imipenem 500mg q6, or
• Meropenem 1g, or
• Doripenem 500mg q8

For most patients who are septic or have septic shock a single antibiotic that can cover pseudomonas will suffice (ceftazidime 2g q8, cefepime 2g q8, zosyn 4.5g, imipenem 500mg q6, ect.). There is a likelihood that the organism involved is gram-negative in most cases and a longer infusion dose strategy is recommended (beta-lactam antibiotics). Some antibiotics are added based on resistance percentages and is usually guided by hospital policies. The addition of an antipseudomonal fluoroquinolone such as ciprofloxacin 400mg IV q12 hours may be indicated.

Lastly, in patients with severe beta-lactam allergies the use of aztreonam is indicated. However the choice of antibiotic should be taken into account, susceptibility should be performed to get a better idea of resistance and proper treatment options.

• Aztreonam 2g q6-8hours

There are new studies that show an increase in pseudomonal infections in patients with sepsis and should be suspected in the hospital setting. P. aeruginosa is indicated for patients who are septic and in the ICU. In regards to the emergency department pseudomonal antibiotics should be indicated for patients presenting with sepsis secondary to pneumonia.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174785/pdf/EMI2018-7581036.pdf

https://www.uptodate.com/contents/gram-negative-bacillary-bacteremia-in-adults?search=sepsis%20anitbiotic%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H13

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