Sepsis of unknown source

Antimicrobial prescribing: NHS Lothian
NHS Lothian

See separate guidance for the following indications::

In patients with only a fever and no evidence of haemodynamic instability or qSOFA <2, consider watchful waiting and senior review.

Consider empirical antibiotic therapy if haemodynamically unstable or qSOFA ≥2. 

Assessment

Assess and manage sepsis using Sepsis 6 where required

Required investigations

  • Blood cultures x2, PRIOR to antibiotic administration
  • Other samples based on clinical suspicions:
    • Sputum culture,
    • urine culture,
    • viral throat swab
    • bacterial throat swab
  • CXR (if indicated)
  • All patients with unexplained fever should be offered HIV testing

Antimicrobial recommendation

Recommended total duration: 5 days (IV and oral) 

Recommended antibiotics

Amoxicillin 1g every 8 hours IV

PLUS

Gentamicin IV (Use NHS Lothian calculator located AMT intranet page)

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

Where suspected skin or soft tissue infection

ADD  Flucloxacillin 2g every 6 hours IV
Penicillin allergy or previously known MRSA 

Vancomycin (Use NHS Lothian calculator located AMT intranet page) - target trough level 10-15mg/L

PLUS

Gentamicin (Use NHS Lothian calculator located AMT intranet page)

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

 

48-72 hour review

Review @48-72h:

  • Review microbiology results and other investigations.
  • If patient no improving call for advice.
  • Where new signs/symptoms develop indicating likely source review the relevant section of the Antimicrobial app.

If no clear source and bacterial infection not likely, STOP ANTIBIOTICS

IV to oral switch recommendation

Recommended duration total = 5 days (IV and oral)

Co-trimoxazole 960mg every 12 hours

CONSIDER ADDING

Metronidazole 400mg every 8 hours orally if intra- abdominal source thought likely