Severe Sepsis - Unknown Focus

Seek microbiology advice. Review regime regularly in light of evolving clinical picture.
Review within 24 hours to confirm diagnosis, then follow appropriate infection specific recommendations
If sepsis has a cutaneous component or is arising from the skin, REFER TO SECTION ON NECROTISING FASCIITIS (under skin/soft tissue infections)

Drug details

Community-acquired infection:

IV amoxicillin 1g every 6 hours
PLUS IV gentamicin - refer to NHS Highland gentamicin dosing guidelines
PLUS IV metronidazole 500mg every 8 hours.

Duration - according to diagnosis.

If Staphylococcus aureus infection suspected:

ADD IV flucloxacillin 2g every 6 hours

Duration - according to diagnosis.

In penicillin allergy, severe renal impairment, acute kidney injury or hospital-acquired infection:

IV aztreonam 2g every 6 hours 
PLUS IV vancomycin - refer to NHS Highland vancomycin dosing guidelines
PLUS IV metronidazole 500mg every 8 hours

Duration - according to diagnosis.

Last reviewed: 31 August 2021

Next review: 31 August 2024

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT177