Sepsis - Unknown Origin | Right Decisions

First Line

Gentamicin IV (as per online calculator) AND Amoxicillin 1g IV 8 hourly AND Metronidazole 500mg IV 8 hourly

- if Staphylococcal infection suspected (eg IVDU) ADD Flucloxacillin 2g IV 6 hourly

- If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Temocillin IV as per High Dose Antibiotic Therapy guidance

- Metronidazole should be prescribed PO after initial IV dose if oral route appropriate as highly bioavailable.

Vancomycin IV as per protocol AND Gentamicin IV as per protocol AND Metronidazole 500mg IV 8 hourly

If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Aztreonam IV dosed per Renal Drug Database

Send blood cultures and other relevant samples

Check previous / recent microbiology results for guidance

Check previous MRSA status

Treatment duration: Guided by source of infection after investigation and clinical response. Refer to appropriate header in guidance.

If there is treatment failure/relapse check microbiology results, seek senior clinical review +/- discuss with Microbiology consultant.