Hospitalized Adults: Septic Shock, Source Unknown: Hospital-Onset or Community Onset with Recent Healthcare Exposure

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Healthcare-associated and/or previous antibiotic therapy

Enterobacteriaceae

S. aureus

Streptococci spp.

P. aeruginosa

Vancomycin

PLUS

Piperacillin/

Tazobactam ID-R: SFGH 4.5 g IV q6h

OR

CefepimeID-R: SFGH VASF 2 g IV q8h

For severe PCN allergy:

Vancomycin

PLUS

Metronidazole 500 mg IV q8h

AND

AztreonamID-R: SFGH 2 g IV q8h

WITH OR WITHOUT:

Tobramycin

For hospital-acquired infection ID consultation is recommended.

 

Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.

 

At UCSF Medical Center, refer to the UCSFMC Code Sepsis Guidelines.

 

For patients with neutropenia, organ transplant, severe hepatic failure, or current/recent (<7 days) piperacillin/tazobactam or cefepime:

Vancomycin

Plus

MeropenemID-R: SFGH VASF 1-2 g IV q8h