Antibiotic Therapy

1. Intravenous antibiotic therapy should be started within the first hour of recognition of severe sepsis, after appropriate cultures have been obtained.

   Grade of Recommendation: E

2. Initial empirical anti-infective therapy should include one or more drugs that have activity against the likely pathogens (bacterial or fungal) and that penetrate into the presumed source of sepsis. The choice of drugs should be guided by the susceptibility patterns of microorganisms in the community and in the hospital.

   Grade of Recommendation: D

3. The antimicrobial regimen should always be reassessed after 48–72 hrs on the basis of microbiological and clinical data with the aim of using a narrow-spectrum antibiotic to prevent the development of resistance, to reduce toxicity, and to reduce costs. Once a causative pathogen is identified, there is no evidence that combination therapy is more effective than monotherapy. The duration of therapy should typically be 7–10 days and guided by clinical response.

   Grade of Recommendation: E

   1. Some experts prefer combination therapy for patients with Pseudomonas infections.

      Grade of Recommendation: E

   2. Most experts would use combination therapy for neutropenic patients with severe sepsis or septic shock. For neutropenic patients, broad-spectrum therapy usually must be continued for the duration of the neutropenia.

      Grade of Recommendation: E

1. If the presenting clinical syndrome is determined to be due to a noninfectious cause, antimicrobial therapy should be stopped promptly to minimize the development of resistant pathogens and superinfection with other pathogenic organisms.

   Grade of Recommendation: E