Sepsis

A child with suspected or proven infection AND at least 2 of the following:

• Core temperature <36°C or >38°C (observed or reported in previous 4 hours)
• Inappropriate tachycardia (Refer to National PEWS)
• Altered mental state (including: sleepiness / irritability / lethargy / floppiness)
• Reduced peripheral perfusion / prolonged central capillary refill / cool or mottled peripheries

Reduced Threshold for Sepsis:

Some children are at higher risk of sepsis. You may consider treatment with fewer signs than above. These include, but are not restricted to:

• Infants under 3 months
• Immunosuppressed / immunocompromised / chemotherapy / long term steroids
• Recent surgery
• Indwelling devices / lines
• Complex neurodisability or other long term conditions (may not present with high PEWS but observations may vary from their baseline)
• High index of clinical suspicion

For neutropenic sepsis associated with haematological / oncological treatment, refer urgently to Paediatric Oncology Guidelines.

Cefotaxime IV

Consider adding Gentamicin if Pseudomonas or other resistant Gram negative infection is suspected

Consider adding Clindamycin if Group A Streptococcal sepsis is suspected

(With no known predisposition to neutropenia due to another condition such as haematological malignancy)

Piperacillin-tazobactam IV

If true penicillin allergy seek Microbiology advice

Take blood cultures before giving antibiotics.

Consider adding Gentamicin if Pseudomonas or other resistant gram negative infection suspected.

Obtain all other microbiology specimens as soon as possible.

Review when culture results are available. Seek Microbiology advice if needed.

Vancomycin IV

Duration: minimum 14 days IV treatment

For information on monitoring serum levels refer to monographs.