Sepsis or Feverish Illness – Unknown Source

Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
NHS Grampian

Neonates - community acquired

Therapy

IV Cefotaxime
+ IV Amoxicillin 

Notes:

If herpes simplex suspected add IV aciclovir

Age over 1 month

Therapy

IV Cefotaxime

Notes:

If herpes simplex suspected add IV aciclovir

If known MRSA carrier or penicillin allergy age over 1 month

Therapy

IV Vancomycin
+ IV Gentamicin

Notes:

If herpes simplex suspected add IV aciclovir

Neonates - nosocomial

Therapy

IV Gentamicin

+ IV Vancomycin

Notes:

If herpes simplex suspected add IV aciclovir

Notes

Seek advice from Medical Microbiology or Paediatric Infectious Diseases specialist. Prompt diagnosis vital to allow early rationalisation of treatment.

Take blood and urine cultures before starting treatment, plus swabs from any other focus of infection e.g. sputum, wounds swabs etc.

Sepsis may be masked in immunosuppression and in the presence of anti-inflammatory drugs and beta-blockers.

Give IV antibiotics to

  • Infants less than 1 month with fever
  • All infants aged 1-3 months with fever who appear unwell
  • Infants aged 1-3 months with WBC less than 5 x 109/L or greater than 15 x 109/L
  • Children over 3 months with fever who are shocked, unrousable or have signs of meningococcal disease

Consider IV antibiotics for

  • Children over 3 months with fever and reduced consciousness