Empirical therapy for surgical site infection associated with sepsis or septic shock
Start antibiotic therapy within 1 hour of the patient presenting to medical care or, for a ward-based patient, developing sepsis or septic shock; antibiotics should be given immediately after appropriate samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.
For surgical site infections associated with sepsis or septic shock, it is usually necessary to combine antibiotic therapy with source control (eg drainage, irrigation, debridement).
For empirical therapy for surgical site infection associated with sepsis or septic shock, use:
piperacillin+tazobactam intravenously. For dosage adjustment in adults with kidney impairment, see piperacillin+tazobactam dosage adjustment piperacillin + tazobactam piperacillin+tazobactam piperacillin+tazobactam
patients without septic shock and not requiring intensive care support: 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) 6-hourly
patients with septic shock or requiring intensive care support: 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) as a loading dose administered over 30 minutes. After 3 hours, start a continuous infusion of 16+2 g (child 400+50 mg/kg up to 16+2 g) administered over 24 hours 1 2
PLUS
vancomycin intravenously; see Vancomycin dosing in adults or Intermittent vancomycin dosing for young infants and children for initial dosing. Loading doses are recommended for critically ill adults. vancomycin vancomycin vancomycin
For patients who report hypersensitivity to a penicillin, seek expert advice.
Modify therapy based on the results of culture and susceptibility testing. If susceptibility results are not available by 72 hours and empirical intravenous therapy is still required—seek expert advice. The total duration of therapy depends on clinical response.