Antimicrobial prescribing: NHS Lothian
Assess and manage sepsis using NEWS2 where required
Sepsis of unknown source
Warning
See separate guidance for the following indications::
In patients with only a fever and no evidence of haemodynamic instability or low risk of severe sepsis severity (NEWS 2 <4), consider watchful waiting and senior review.
- Blood cultures x2, PRIOR to antibiotic administration
- Other samples based on clinical suspicions:
- Sputum culture,
- urine culture,
- viral throat swab
- bacterial throat swab
- CXR (if indicated)
- All patients with unexplained fever should be offered HIV testing
Recommended total duration: 5 days (IV and oral)
| Recommended antibiotics |
Amoxicillin 1g every 8 hours IV PLUS Gentamicin IV (Use NHS Lothian calculator located AMT intranet page) PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable) Where suspected skin or soft tissue infection ADD Flucloxacillin 2g every 6 hours IV |
| Penicillin allergy or previously known MRSA |
Vancomycin (Use NHS Lothian calculator located AMT intranet page) - target trough level 10-15mg/L PLUS Gentamicin (Use NHS Lothian calculator located AMT intranet page) PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable) |
Review @48-72h:
- Review microbiology results and other investigations.
- If patient no improving call for advice.
- Where new signs/symptoms develop indicating likely source review the relevant section of the Antimicrobial app.
If no clear source and bacterial infection not likely, STOP ANTIBIOTICS
Recommended duration total = 5 days (IV and oral)
Co-trimoxazole 960mg every 12 hours
CONSIDER ADDING
Metronidazole 400mg every 8 hours orally if intra- abdominal source thought likely