Join the EMGuideWire crew once again for this
month's series on Sepsis in honor of Sepsis Awareness
month. Episode 3 will cover antibiotic use and
selection.
Antibiotics
for Sepsis
Take
a history and perform a chart
biopsy first! Consider past infections, bug
susceptibilities, healthcare acquired vs. community acquired
infection, foreign travel, and comorbidities.
Always check local antibiogram
and prior culture results.
Septic shock - Start broad spectrum
antibiotics within 1 hour.
Stable patient - find the
source! UA, CXR, and a good skin exam are fast and can
help guide antibiotic choice. Remember some patients need surgical
management!
2nd
agent - Choose based on patient characteristics
Ceftriaxone - simple community acquired
infections.
Vancomycin - covers MRSA.
Meropenem - use for patients with a hx of
ESBL.
Flagyl + cefepime/meropenem - Use for
intra-abdominal infections.
Clindamycin - Useful for skin infections (toxin
suppression).
Cefazolin - IV line infections, endocarditis,
soft tissue infections w/o MRSA (covers MSSA, GAS,
GBS).
Summarized by: Travis Barlock,
MD PGY-1
References:
Alam
N et al. 2018. Prehospital antibiotics in the ambulance for sepsis:
a multicentre, open label, randomised trial.The Lancet. Respiratory
Medicine.6(1):
40-50.
Dellinger RP, Levy MM, Rhodes
A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee
including the Pediatric Subgroup: Surviving sepsis campaign:
international guidelines for management of severe sepsis and septic
shock: 2016.Critical
Care Medicine.
44(3):486-552.
Join the faculty and residents of Carolinas Emergency Medicine Residency Program, one of the oldest programs in the country, as they explore some of the Core Concepts of Emergency Medicine as well as many of the niche environments of this important arena of specialty care.