SEP 1 Sepsis - unknown pathogen and unknown focus

Recommendations

≥ 18 years
	Дозування	Ремарки
	cefuroxime IV 1500 mg three times daily + amikacin IV 20 mg/kg single dose	For sepsis (qSOFA ≥ 2)
	cefuroxime IV 1500 mg three times daily	If no sepsis (qSOFA < 2) and community-acquired
	piperacillin/tazobactam IV continuous per 24 hours or piperacillin/tazobactam IV 4000/500 mg four times daily	If no sepsis (qSOFA<2) and hospital-acquired Dosage for continuous infusion: first load with 4000/500 mg over 30 minutes, then 16,000/2,000 mg continuous per 24 hours.

Comments

See here for Fever and sepsis in neutropenic patients

In case of (suspected) allergy to penicillins and/or cephalosporins:

See protocol allergy to antibiotics

Consult the clinical microbiologist/infectious diseases physician for an alternative regimen.

Contraindications to amikacin:

eGFR <30 ml/min/1.73 m2 (CKD-EPI)
Acute deterioration of renal function (defined as a serum creatinine that is twice as high as the pre-existing serum creatinine)
Bilirubin > 100 μmol/l
Kidney transplantation
Tubulotoxic co-medication
Neuromuscular disorders (myasthenia gravis, Lambert-Eaton syndrome)
Pregnancy

Caution if eGFR 30-45 ml/min/1.73 m2 (CKD-EPI)

There are circumstances in which the estimated renal function differs from the actual renal function, for example in patients with low muscle mass or with a deteriorating renal function. Avoid amikacin in such cases.

SEP 1 Sepsis - unknown pathogen and unknown focus

≥ 18 years