Sepsis of unknown origin

NHS Dumfries & Galloway Antimicrobial Handbook
NHS Dumfries and Galloway

Review previous microbiology results: If resistant target organisms previously isolated (e.g. MRSA, ESBL, known resistance to empirical antibiotic choices), discuss antibiotic choice with Paediatric and/or Microbiology Consultant.

User guide: for further advice regarding antimicrobial prescribing good practice, oral switch, penicillin allergy, dosing, and safety considerations: HERE

Focus of infection identified: treat as per localised infection.

Neonatal: Early onset, <72 hours of age

First line

IV benzylpenicillin 
and IV gentamicin

Penicillin allergy

Discuss with microbiology

TOTAL duration
  • With clinical improvement, and on advice from Paediatric Consultant and/or Microbiology Consultant.
Comments
  • Further advice can be found within the Antibiotic Guideline for the Neonatal Unit section of the West of Scotland Neonatal Guidelines:  HERE

Neonatal: Late onset, >72 hours of age

First line

IV cefOTAXime 
and IV amoxicillin 
and IV gentamicin

Penicillin allergy

Discuss with microbiology

TOTAL duration
  • With clinical improvement, and on advice from Paediatric Consultant and/or Microbiology Consultant.
Comments
  • Further advice can be found within the Antibiotic Guideline for the Neonatal Unit section of the West of Scotland Neonatal Guidelines:  HERE

1 month and above: Community-acquired

First line

IV cefOTAXime
add IV gentamicin if severe sepsis

Consider adding IV amoxicillin for Listeria cover up to 6 weeks of age, if meningitis cannot be excluded.

Penicillin allergy (severe)

Discuss with microbiology

TOTAL duration
  • With clinical improvement, and on advice from Paediatric Consultant and/or Microbiology Consultant.

1 month and above: Hospital-acquired

First line

IV piperacillin/tazobactam
add IV gentamicin if severe sepsis

Penicillin allergy

Discuss with microbiology

TOTAL duration
  • With clinical improvement, and on advice from Paediatric Consultant and/or Microbiology Consultant.

Editorial Information

Last reviewed: 20/02/2024

Next review date: 20/02/2026

Author(s): Dr Jon van Aartsen (Consultant Microbiologist), Dr Jed Bamber (Consultant Paediatrician).

Version: v1.0

Approved By: AMT (20.02.2024) and ADTC (28.02.2024)

Reviewer name(s): Dr Jed Bamber (Consultant Paediatrician), AMS Team.