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Hospitalized Adults: Septic Shock, Source Unknown: Hospital-Onset or

Community Onset with Recent Healthcare Exposure

Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.
Some antimicrobials are restricted (ID-R). Click on link for guidelines on obtaining authorization.

Common Drug(s) of Alternative

Diagnosis Comments
Pathogens First Choice Drug(s)
 For hospital-acquired infection ID
consultation is recommended.

For severe PCN

allergy:
Weigh risks and benefits of adding
Vancomycin [1] aminoglycoside for critical illness,
Vancomycin [1] immunocompromise, or history of infection
PLUS or colonization with drug-resistant Gram-
PLUS negative rods.
Metronidazole [2]
Enterobacteriaceae Piperacillin/ [2] 500 mg IV q8h
Healthcare-
S. aureus Tazobactam [2] ID- AND At UCSF Medical Center, refer to the
associated and/or R: SFGH [3] 4.5 g
UCSFMC Code Sepsis Guidelines. [6]
previous Streptococci spp. IV q6h Aztreonam [2]ID-R:
antibiotic therapy SFGH [3] 2 g IV q8h
P. aeruginosa OR
WITH OR For patients with neutropenia, organ
Cefepime [2]ID-R: WITHOUT: transplant, severe hepatic failure, or
SFGH [3] VASF [4] 2 current/recent (<7 days)
g IV q8h Tobramycin [5] piperacillin/tazobactam or cefepime:

Vancomycin [1]

Plus

Meropenem [2]ID-R: SFGH [3] VASF [4] 1-2 g

IV q8h

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Source URL: https://idmp.ucsf.edu/hospitalized-adults-septic-shock-source-unknown-hospital-onset-or-community-onset-recent-

healthcare?mag_q=printpdf/366

Links
[1] http://idmp.ucsf.edu/vancomycin-dosing-and-monitoring-recommendations
[2] http://idmp.ucsf.edu/adult-antimicrobial-dosing-non-dialysis
[3] http://idmp.ucsf.edu/restricted-antimicrobials-san-francisco-general-hospital
[4] http://idmp.ucsf.edu/restricted-antimicrobials-veterans-affairs-medical-center-san-francisco
[5] http://idmp.ucsf.edu/aminoglycoside-dosing-and-monitoring-recommendations
[6] https://idmp.ucsf.edu/ucsfmc-code-sepsis-policy-and-procedure