Join the EMGuideWire crew once again for this month's series on Sepsis in honor of Sepsis Awareness month. Episode 3 will cover antibiotic use and selection.

Antibiotics for Sepsis

• Take a history and perform a chart biopsy first! Consider past infections, bug susceptibilities, healthcare acquired vs. community acquired infection, foreign travel, and comorbidities. 
• Always check local antibiogram and prior culture results.
• Septic shock - Start broad spectrum antibiotics within 1 hour.
• Stable patient - find the source! UA, CXR, and a good skin exam are fast and can help guide antibiotic choice. Remember some patients need surgical management! 
• Antibiotic choice in septic shock.
• • 1st agent - Piperacillin/Tazobactam (covers GP/GN + Pseudo) 
  • 2nd agent - Choose based on patient characteristics
  • • Ceftriaxone - simple community acquired infections.
    • Vancomycin - covers MRSA.
    • Meropenem - use for patients with a hx of ESBL.
    • Flagyl + cefepime/meropenem - Use for intra-abdominal infections.
    • Clindamycin - Useful for skin infections (toxin suppression). 
    • Cefazolin - IV line infections, endocarditis, soft tissue infections w/o MRSA (covers MSSA, GAS, GBS). 

Summarized by: Travis Barlock, MD PGY-1

References:

• Alam N et al. 2018. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet. Respiratory Medicine. 6(1): 40-50. 
• Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.