Sepsis of unknown source

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

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

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)

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

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