Choosing Empiric Antibiotics in Sepsis and Septic Shock - ICU Guide
Channel: QuickGuidesForMedicine
Date: 2020-08-13

In this video I go through some of the considerations in the selection of antibiotics in sepsis and septic shock. See notes below

Common Antibiotic recommendation for Empiric therapy

Goal is to provide good gram+ve and gram-ve coverage and potentially fungal coverage in patients with risk of candida sepsis (Neutropenic patients). The antibiotics are usually tailored towards the most virulent organisms such as MRSA and Pseudomonas. 

Gram +ve Coverage options

Vancomycin: Because of the risk of MRSA in both hospitalized patients and even patients admitted from the community (Community MRSA), Vancomycin provides an excellent empiric option in Sepsis/septic shock. It also covers a wide variety of other gram +ve organisms

alternatives to vancomycin in patients with failure of vancomycin or contraindications to vancomycin include Linezolid or Daptomycin (does not work well for pulmonary pathogens).

Please note renal failure is not a contraindication to empiric vancomycin use as long as it is dosed according to renal function (generally in ESRD or CKD patients dose per random or trough levels)

Gram -ve Coverage options

Cefepime: Cefepime provides a remarkable advantage due to its pseudomonal coverage. Options in patients who are not suspected of pseudomonal infection includes Ceftriaxone. 

Fungal Coverage Options

Echinocandins: These medications for example Micafungin provides good candidal coverage even for the rarer candida species such as glabrata and krusei. These are more specifically considered in neutropenic patients

Voriconazole: May be considered in patients suspected of Aspergillus infection e.g immunocompromised patients.

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