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. 

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