Septic Shock

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Empiric antibiotic therapy in Septic shock
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Sepsis: life-threatening organ dysfunction caused by dysregulated host response to infection.

Septic shock: sepsis that has circulatory, cellular, and metabolic abnormalities that are associated with greater risk of mortality than sepsis alone. 		Fever, Systolic blood pressure < 90 mmHg, hypoxia, heart rate> 90b/m, tachypnea , cyanosis, alter mental status, Ileus, deteriorate renal function.

Select one of the following antibiotics:

  • Vancomycin 20 - 35 mg/kg/loading then 15 - 20 mg/kg IV every 8 to 12 hours
  • Daptomycin 6 - 10 mg/kg IV every 24 hours (for non-pulmonary MRSA)
  • Linezolid 600 mg IV every 12 hours (for pulmonary MRSA)

PLUS

Select one of the following antibiotics:

  • Ceftazidime 2 g IV every 8 hours
  • Cefepime 2 g IV every 8 hours
  • Piperacillin/Tazobactam 4.5 g IV every 6 hours
  • Imipenem/Cilastatin 500mg IV every 6 hours
  • Meropenem 1 g IV every 8 hours

PLUS/Minus*

Select one of the following antibiotics:

  • Amikacin 15 - 30 mg/kg IV every 24 hours
  • Gentamycin 5 - 7 mg/kg IV every 24 hours
  • Ciprofloxacin 400 mg IV every 12 hours
  • Levofloxacin 750 mg every 24 hours
-For patients who allergic to beta lactams, including carbapenems, aztreonam is an alternative.

-Many patients with reported penicillin allergies can tolerate cephalosporins and carbapenems

*Depend on the alikehood of Pseudomonas, severity of infection
Duration: should be individualized for most patients, typically 3- 8 days , however, longer courses are appropriate in patients who have a slow clinical response.
References:

UpToDate 2025