Empiric Antibiotics: Septic Shock

Principles

  • Goal is “the administration of effective IV abx within 1st hour of recognition of septic shock or severe sepsis.” — (grade 1B and 1C, respectively)
  • Initial empiric Rx should include “one or more drugs active against all likely pathogens with adequate penetration into tissues presumed to be source of sepsis.” — (grade 1B)
  • Abx should be “reassessed daily for potential de-escalation.” — (grade 1B)
  • Combination therapy, when used empirically for severe sepsis, should not be continued more than 3-5 days” but de-escalate to single-agent therapy as soon as susceptibilities are known.” — (grade 2B)
  • Source control in first 12 hours if feasible. — (grade 1C)

Empiric Therapy

  • Empiric Rx depends on host factors, recent abx exposure, allergies, clinical syndrome and likely site of infection, local antibiogram and pt’s prior infections or colonization
  • Combination therapy recommended in neutropenics with severe sepsis, those with prior MDR pathogens, and respiratory failure or septic shock patients. — (grade 2B)
  • Practically, this usually means vancomycin + anti-Pseudomonal beta-lactam + either aminoglycoside or anti-Pseudomonal FQ

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Surviving Sepsis Campaign International Guidelines: 2012 Crit Care Med Feb 2013; 41(2): 580-637.