Adults with sepsis or septic shock associated with a bone or joint source

For adults, the regimens below are recommended for initial therapy (up to 48 hours) of sepsis or septic shock associated with a bone or joint source. Modify therapy as soon as additional information is available (eg results of Gram stain, culture and susceptibility testing). If the results of culture or susceptibility testing are not available by 72 hours and intravenous therapy is still required, stop the aminoglycoside-containing regimen and seek expert advice. Evaluate appropriateness of antibiotic therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardship.

For empirical therapy for adults with sepsis or septic shock associated with a bone or joint source, 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

flucloxacillin 2 g intravenously, 4-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin intravenous dosage adjustment flucloxacillin flucloxacillin flucloxacillin

PLUS

vancomycin 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g intravenously, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults. vancomycin vancomycin vancomycin

For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, 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

cefazolin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment cefazolin cefazolin cefazolin

PLUS

vancomycin 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g intravenously, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults. vancomycin vancomycin vancomycin

For adults who have had a severe immediate¹ hypersensitivity reaction to a penicillin, the cefazolin-based regimen (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For adults who have had a severe immediate¹ hypersensitivity reaction to a penicillin in whom the cefazolin-based regimen is not used, or for patients who have had a severe delayed² hypersensitivity reaction to a penicillin, 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

vancomycin 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g intravenously, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults. vancomycin vancomycin vancomycin

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return