Antibiotics for Sepsis

Join the EMGuideWire crew once again for this month's series on Sepsis in honor of Sepsis Awareness month. Episode 3 will cover antibiotic use and selection. Antibiotics for Sepsis Take a history and perform a chart biopsy first! Consider past infections, bug susceptibilities, healthcare acquired vs. community acquired infection, foreign travel, and comorbidities.  Always check local antibiogram and prior culture results. Septic shock - Start broad spectrum antibiotics within 1 hour. Stable patient - find the source! UA, CXR, and a good skin exam are fast and can help guide antibiotic choice. Remember some patients need surgical management!  Antibiotic choice in septic shock. 1st agent - Piperacillin/Tazobactam (covers GP/GN + Pseudo)  2nd agent - Choose based on patient characteristics Ceftriaxone - simple community acquired infections. Vancomycin - covers MRSA. Meropenem - use for patients with a hx of ESBL. Flagyl + cefepime/meropenem - Use for intra-abdominal infections. Clindamycin - Useful for skin infections (toxin suppression).  Cefazolin - IV line infections, endocarditis, soft tissue infections w/o MRSA (covers MSSA, GAS, GBS).  Summarized by: Travis Barlock, MD PGY-1 References: Alam N et al. 2018. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet. Respiratory Medicine. 6(1): 40-50.  Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.