Penicillin hypersensitivity regimens for sepsis or septic shock associated with acalculous cholecystitis

For children with sepsis or septic shock associated with acalculous cholecystitis, seek expert advice.

For adults with sepsis or septic shock associated with acalculous cholecystitis who have hypersensitivity to penicillins, use:

1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing gentamicin gentamicin gentamicin

OR

1tobramycin intravenously; see Tobramycin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing tobramycin tobramycin tobramycin

PLUS with either of the above drugs

clindamycin 600 mg intravenously, 8-hourly1. clindamycin clindamycin clindamycin

If prompt source control is unlikely to occur (eg within 24 hours), consider adding metronidazole because there is increasing resistance to clindamycin in gram-negative anaerobes (especially Bacteroides species); add:

metronidazole 500 mg intravenously, 12-hourly. metronidazole metronidazole metronidazole

If the patient is improving, source control has been achieved, sepsis is resolving, and culture and susceptibility results are not yet available, consider switching to empirical therapy for acute acalculous cholecystitis.

1 There are more clinical and microbiological data to support the use of clindamycin than lincomycin. Intravenous lincomycin can be used at the same dosage if clindamycin is unavailable or if a local protocol recommends its use.Return