Penicillin hypersensitivity regimens for sepsis and septic shock from a biliary or gastrointestinal tract source

The empirical regimens below are recommended for initial therapy (up to 48 hours) for sepsis or septic shock from a biliary or gastrointestinal tract source in adults and children with hypersensitivity to penicillins. Modify therapy as soon as additional information is available (eg results of Gram stain, culture and susceptibility testing). Evaluate appropriateness of antimicrobial therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardship.

Empirical regimens are included for patients with hypersensitivity to penicillins who have sepsis or septic shock:

• from a biliary or gastrointestinal tract source other than acalculous cholecystitis
• associated with acalculous cholecystitis.

See Approach to managing sepsis or septic shock from a biliary or gastrointestinal tract source for advice on the appropriateness of the regimens below in:

• neonates
• patients with risk factors for infection with a multidrug-resistant gram-negative bacterium
• patients with hospital-acquired infection
• patients at increased risk of invasive candidiasis
• patients who will undergo surgery.