GUIDE FOR CHOICE OF EMPIRICAL THERAPY IN SEPSIS OR SEPTIC SHOCK 

Initiate empirical broad spectrum antibiotic regimens targeting the most likely pathogens for the suspected infections. Evaluate appropriateness of antimicrobial therapy daily, with consideration given to the patient’s clinical assessment and improvement. Modify antibiotic therapy in 48 to 72 hours once additional information is available (E.g.: source of infection, imaging, results of Gram stain, culture and susceptibility testing). Review the appropriateness of antibiotic regimen chosen for opportunities to de-escalate or potentially discontinue therapy if infection is unlikely according to the principles of Antimicrobial Stewardship.

The choice of empirical regimen should be guided by:

• age (E.g.: neonates, paediatric or adult) 

• where the infection was acquired (i.e. in the community or in hospital), or is associated with healthcare-contact or overseas travel

• recent culture and susceptibility testing if available

• risk factors for the likelihood of drug-resistant infection including history of prior infection, known colonisation, and ecologic data from the hospital and the community of origin

• whether local microbiology and antimicrobial susceptibility is known 

• whether the patient is neutropenic or immunocompromised

• exposure risk or risk factor for acquiring infections which is locally endemic (E.g.: melioidosis, typhoid, leptospirosis)

When the source of sepsis or septic shock is apparent (E.g.: sepsis or septic shock that develops in a patient with pneumonia or urinary tract infection), antibiotic choice is guided by the usual susceptibility of pathogens associated with the source.

Refer related section. 

References: 

1. Strich JR, Heil EL, Masur H. Considerations for Empiric Antimicrobial Therapy in Sepsis and Septic Shock in an Era of Antimicrobial Resistance. J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-S131. doi: 10.1093/infdis/jiaa221. PMID: 32691833; PMCID: PMC7372215.