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EMGuidewire's Podcast

Sep 16, 2019

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! 
  • Antibiotic choice in septic shock.
    • 1st agent - Piperacillin/Tazobactam (covers GP/GN + Pseudo) 
    • 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


  • 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.