Clinical Study

Implementing a Collaborative Sepsis Protocol on the Time to Antibiotics in an Emergency Department of a Saudi Hospital: Quasi Randomized Study

Table 1

Empiric antibiotic therapy for cases of severe sepsis or septic shock.

Suspected source of infectionAntibiotic guidelines

Lung
 Community acquiredMoxifloxacin + cefotaxime or ceftriaxone or ceftazidime
 Hospital acquiredImipenem or meropenem or cefepime
Abdomen
 Community acquiredImipenem or meropenem or piperacillin/tazobactam ± aminoglycoside
 Hospital acquiredImipenem or meropenem or piperacillin/tazobactam ± aminoglycoside
(consider amphotericin B)
Skin and soft tissue
 Community acquiredVancomycin + imipenem or meropenem or piperacillin/tazobactam
 Hospital acquiredVancomycin plus Cefepime or piperacillin/tazobactam
Urinary tract
 Community acquiredCiprofloxacin or ampicillin and gentamycin
 Hospital acquiredVancomycin and cefepime or carbapenem
Meningitis
 Community acquiredVancomycin + ceftriaxone or cefepime
 Hospital acquiredVancomycin + cefepime or ceftazidime
Neutropenic
 Community acquiredCarbapenem or cefepime or ceftazidime or piperacillin/tazobactam + aminoglycoside + Vancomycin (if having CVC catheter)
 Hospital acquiredSame as above
Undetermined
 Community acquiredVancomycin + imipenem or meropenem or cefepime
 Hospital acquiredSame as above

Recommended starting antibiotic dosage for treating sepsis (normal renal function): imipenem: 0.5 gm IV; meropenem: 1.0 gm IV; piperacillin/tazobactam: 3.375 gm IV; cefepime: 1.2 gm IV; ciprofloxacin: 400 mg IV; moxifloxacin: 400 mg IV; vancomycin: 1 g IV; ceftriaxone: 2 gm IV; cefotaxime: 2 gm IV; ceftazidime: 2 g IV.