These guidelines are intended for patients who meet criteria for severe sepsis:
Probable or documented infection AND
Systemic inflammatory response criteria AND
Specific evidence of hypo-perfusion or organ dysfunction not explained by an alternative process:
Cardiovascular dysfunction, OR
Acute respiratory distress syndrome, OR
Dysfunction in two or more other organ systems
Refer to consensus definitions for additional detail
These guidelines are not intended for "rule out" scenarios in clinically stable patients; patients presenting with signs and/or symptoms of infection but not meeting criteria for severe sepsis should either be monitored without antibiotic therapy in appropriate circumstances or receive empiric antibiotics selected based on the suspected source and risk factors.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Severe sepsis, 0-28 days old, community-onset, previously healthy (admitted from home) See BCH SF Guidelines for Sepsis in the ICN for empiric therapy in neonates who develop severe sepsis while hospitalized |
Enteric gram-negative bacteria Group B streptococcus Less Common: Staphylococcus aureus Listeria monocytogenes Herpes simplex virus |
Ceftazidime AND Ampicillin REPLACE Ampicillin with Vancomycin if suspected skin, soft tissue, bone or joint source ADD Acyclovir pending HSV evaluation if not already completed |
For continuation of therapy if indicated after initial stabilization in appropriate circumstances, Ceftriaxone may be used in place of Ceftazidime if neonate meets specific safe use criteria |
ID consult recommended Evaluation for meningitis via LP is recommended as soon as able Refer to Neonatal Dosing Guideline for antibiotic doses and intervals Refer to Fever Without a Source section if patient does not meet criteria for severe sepsis Antibiotic therapy should be re-evaluated at <= 48 hours and narrowed to target the identified source/pathogen. If a specific source or pathogen is not identified it is still recommended to narrow therapy in most circumstances. If Vancomycin was initiated, it should be discontinued at this time unless a resistant gram-positive pathogen is identified OR there is a clinically documented source of infection with higher likelihood of resistant gram-positive etiology. |
| Severe sepsis, > 28 days old, community-onset, no preexisting comorbidities or recent healthcare exposure |
Staphylococcus aureus Streptococcus pneumoniae Group A streptococcus Neisseria meningitidis Enteric gram-negative bacteria |
Ceftriaxone (dosing for non-CNS infection; refer to Meningitis section if meningitis is suspected) AND (follow link for dosing & monitoring) Consult a clinical pharmacist for patient-specific Vancomycin recommendations if there is evolving kidney injury ADD Metronidazole |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Aztreonam
|
ID consult recommended Antibiotic therapy should be re-evaluated at <= 48 hours and narrowed to target the identified source/pathogen If Vancomycin was initiated, it should be discontinued at this time unless a resistant gram-positive pathogen is identified OR there is a clinically documented source of infection with higher likelihood of resistant gram-positive etiology. |
References:
Weiss SL, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21:e52-e106.
Goldstein, et al. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.