Choice of empirical antibiotic regimen for sepsis or septic shock when the source is apparent

When the source of sepsis or septic shock is apparent (eg sepsis or septic shock that develops in a patient with pneumonia), antibiotic choice is guided by the usual susceptibility of pathogens associated with the source. For treatment recommendations for common sources of sepsis in adults and children, see:

• respiratory sources
  • community-acquired pneumonia in adults
  • community-acquired pneumonia in children
  • hospital-acquired pneumonia
• urinary tract sources
  • in adults
  • in children
• biliary or gastrointestinal tract source
• skin sources
  • cellulitis
  • severe infection of diabetes-related foot ulcers, including for sepsis associated with a chronic ulcer (eg decubitus or ischaemic ulcer)
  • necrotising skin or soft tissue infections, including for sepsis associated with a water-immersed wound
  • Staphylococcal scalded skin syndrome
  • surgical site infection
• meningitis
  • adults and children 2 months or older
  • neonates and children younger than 2 months
• cardiovascular sources
  • intravenous catheter source
  • infective endocarditis
  • cardiac implantable electronic device lead endocarditis
• bone or joint sources
• arthroplasty device source
• female genital tract sources
  • pelvic inflammatory disease
  • postprocedural pelvic infection
  • intra-amniotic infection (chorioamnionitis)
  • postpartum endometritis
• neck or oropharyngeal sources
  • septic jugular thrombophlebitis
  • acute epiglottitis.

In patients with hospital-acquired infection, the spectrum of pathogens and their susceptibility can be difficult to predict. Local protocols, clinical microbiology or infectious diseases advice should guide antibiotic choice.

In neonates, the source of infection is often not apparent or there may be multiple sites of infection (eg meningitis with concurrent bacteraemia and urinary tract infection). For these reasons, empirical antimicrobial regimens for neonates target a broad range of pathogens. These guidelines include limited advice on antimicrobial therapy for neonatal sepsis or septic shock when the source of infection is apparent – seek expert advice.