Pre-hospital and Community Hospital use of antibiotics for treatment of sepsis in adults (Antimicrobial)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Administration of intravenous antibiotics in the community to patients with suspected sepsis is challenging.  Many of the recommended antibiotic combinations in the current Management of Infection Guidance are not suitable for administration in the community setting as they include infusions and complex dose calculations according to renal function.  The following information is designed for use by practitioners assessing and providing initial management of patients with suspected sepsis in the community.  The agents chosen can all be given by bolus intravenous injection and some by intramuscular injection.  A number of oral or per rectum options are also given.

Alternative option (if only have stock drugs in GP bag or OOHs centre)

Please note a change of dose for cefotaxime for sepsis - this is a consensus recommendation from Scottish Antimicrobial Prescribing Group. For further information on reconstitution see:

  • Injectable medicines guide: Medusa (NHS Highland intranet access required or login) and SPC.
Indication  First line  Beta-lactam anaphylaxis  Notes 
Meningitis Benzyl penicillin 1·2g IV/IM OR ceftriaxone OR cefotaxime 2g IV/IM (for IM administration: administer as 2 separate 1g injections at separate sites and reconstitute with 1% lidocaine to reduce pain at the injection site) Chloramphenicol* 25mg/kg IV Doses as per existing guidelines
Sepsis of unknown origin Ceftriaxone OR cefotaxime 2g IV/IM (for IM administration: administer as 2 separate 1g injections at separate sites and reconstitute with 1% lidocaine to reduce pain at the injection site) Chloramphenicol* 25mg/kg IV  

* Chloramphenicol injection should be held as stock in rural areas for use in patients with confirmed anaphylaxis to penicillin as use of cephalosporin not advised in these patients.

Preferred option (ONLY if a range of antibiotic injections are available)

Administer the most appropriate antibiotic available, preferably intravenously (IV), depending on likely sepsis source.  This guidance applies in a community hospital setting where a greater range of medications are available.  If intravenous access not available, administer intramuscularly (IM) (if drug suitable) or high dose oral if patient can take. 

Indication

First line

Beta-lactam anaphylaxis

Notes

Meningitis

IV/IM benzyl penicillin OR
IV/IM ceftriaxone/cefotaxime

Chloramphenicol 25mg/kg IV

Doses as per existing guidelines

Sepsis of unknown origin

Amoxicillin 1g IV/IM PLUS
aztreonam 2g IV/IM PLUS
metronidazole 800mg (oral) OR 1g (PR)

Teicoplanin 800mg IV/IM in place of amoxicillin and flucloxacillin, rest as before (if the patient weighs less than 65kg, give 400mg teicoplanin)

If Staphylococcus aureus infection suspected: ADD flucloxacillin 2g IV/IM
Note max single IM dose is 500mg per site. Give 2g dose over 4 injection sites.

Respiratory

Amoxicillin 1g IV/IM PLUS
doxycycline 200mg (oral)

Levofloxacin 500mg (oral) (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))

Aspiration pneumonia: ADD metronidazole 800mg (oral) OR 1g (PR)

UTI

Aztreonam 2g IV/IM

Ciprofloxacin 750mg twice daily (oral) (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))

Co-amoxiclav 625mg (oral)

SSTI

Flucloxacillin 2g IV/IM
Note max single IM dose is 500mg per site. Give 2g dose over 4 injection sites.

Teicoplanin 800mg IV/IM
(if the patient weighs less than 65kg, give 400mg teicoplanin)

If no teicoplanin, give cefotaxime 1g IV/IM

Intra-abdominal sepsis

As for sepsis of unknown origin (flucloxacillin not required).

For glossary of terms see Glossary.

Editorial Information

Last reviewed: 25/08/2022

Next review date: 25/08/2025

Author(s): Antimicrobial Management Team.

Version: 2.2

Approved By: TAM subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT174