Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic

Treatment Guidelines for Sepsis Syndromes in Adults

 COMMUNITY-ACQUIRED PNEUMONIA
 HEALTHCARE-ASSOCIATED PNEUMONIA
 INTRA-ABDOMINAL INFECTION
 URINARY TRACT INFECTION (WITH AND WITHOUT A FOLEY CATHETER)
 CELLULITIS, ERYSIPELAS, AND NECROTIZING FASCIITIS
 DIABETIC FOOT INFECTION
 MENINGITIS AND ENCEPHALITIS
 FEBRILE NEUTROPENIA
 CLOSTRIDIUM DIFFICILE INFECTION
 UNKNOWN SOURCE OF INFECTION
 INTRODUCTORY LETTER THAT WAS SENT TO PRACTITIONERS

General notes for this document:

1) These guidelines recommend antimicrobial therapy for empiric treatment. Antibiotics are to be adjusted based on cultures and clinical response.
2) Severe penicillin allergy: Avoid piperacillin/tazobactam and cephalosporins, but meropenem is reasonable to give in severe sepsis or greater even with
history of penicillin/ampicillin anaphylaxis but with close observation. References since 2006 suggest cross reaction ~1% or less. Consult Infectious Disease if in
doubt for clarification or alternatives.
3) Renal impairment: Doses of antibiotics are for patients with normal renal function. Dose adjustment of some of the antibiotics may be required for patients
with renal impairment.
4) For pregnancy: These guidelines do not specifically address contraindicated antimicrobials (including fluoroquinolones).
5) XDRO = eXtensively drug resistant organisms: typically Gram negative bacteria resistant to all but 2 classes of routinely used antibiotics.
6) References can be found in the provincially approved treatment guidelines for the specific infectious syndrome or available upon request.

Developed by: the Provincial Antibiotic Advisory Team (PAAT). Members include: Dr. Greg German (Infectious Disease Consultant and Health PEI Medical Microbiologist),
Jennifer Boswell (Provincial Antimicrobial Stewardship Pharmacist), Wendy Cooke (QEH ICU/CCU Clinical Pharmacist), Trent Ferrish (PCH Pharmacist)

Health PEI Physician Reviewers: Dr. Lenley Adams, Dr. Patrick Bergin, Dr. Greg German, Dr. Michael Irvine, Dr. Paul Seviour; and limited to specific syndromes: Dr. Philip
Champion (febrile neutropenia), Dr. Barry Fleming (intra-abdominal)

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
(Amoxicillin 1000 mg PO TID OR Ampicillin 2 g IV Ceftriaxone 2 g IV q24h + (Azithromycin 500 Meropenem 1g IV q8h
q6h) + (Azithromycin 500 mg PO/IV q24h OR mg IV q24h OR Levofloxacin 750 mg IV q24h) + Levofloxacin 750 mg IV q24h
Clarithromycin 500 mg PO BID) + (Linezolid 600 mg PO/IV q12h OR
If macroaspiration, antibiotics in past 3 Vancomycin 25 mg/kg IV load, then
Severe PCN allergy and no previous months, preceding URTI or influenza: 15 mg/kg IV q12h)
fluoroquinolone in 90 Days: Piperacillin/Tazobactam 4.5 g IV q6h
Levofloxacin 750 mg PO/IV q24h + (Azithromycin 500 mg IV q24h OR If fluoroquinolone contraindicated
Levofloxacin 750 mg IV q24h) or previous resistance noted:
If macroaspiration: Meropenem 1 g IV q8h
ADD Metronidazole 500 mg PO/IV q12h Severe PCN allergy: + Tobramycin 7 mg/kg IV q24h
OR Meropenem 1 g IV q8h + (Azithromycin 500 + Azithromycin 500 mg IV q24h
USE Amoxicillin/Clavulanate 500/125 mg PO TID mg IV q24h OR Levofloxacin 750 mg IV q24h ) + (Linezolid 600 mg PO/IV q12h OR
(higher risk of Cdiff). OR Vancomycin 25 mg/kg load, then 15
Levofloxacin 750 mg IV q24h + Tobramycin 7 mg/kg IV q12h)
Depending on season or travel history: mg/kg IV q24h + Metronidazole 500 mg IV
Community-Acquired
Consider ADDING Oseltamivir 75 mg PO BID q12h (if macroaspiration) Depending on season or travel
Pneumonia
history: Consider ADDING
MRSA confirmed or suspected: Oseltamivir 75 mg PO BID
ADD Linezolid 600 mg PO/IV q12h OR
Vancomycin 25 mg/kg IV load, then 15 mg/kg
IV q12h

Depending on season or travel history:

Consider ADDING Oseltamivir 75 mg PO BID

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Treatment dependent on previous exposure to [Piperacillin/Tazobactam 4.5 g IV q6h OR Meropenem 1 g IV q8h +
antibiotics in 90 days (avoid using an antibiotic Meropenem 1 g IV q8h (if severe PCN allergy Ciprofloxacin 400 mg IV q8h
from the same class) or previous XDRO5)] + (Levofloxacin 750mg + (Linezolid 600 mg PO/IV q12h OR
IV q24h OR Ciprofloxacin 400mg IV q8h if > Vancomycin 25 mg/kg IV load, then
Ceftriaxone 2 g IV q24h (if macroaspiration ADD 70kg, q12h otherwise) 15 mg/kg IV q12h )
Metronidazole 500 mg PO/IV q12h)
OR MRSA confirmed or suspected: If Ciprofloxacin contraindicated or
Healthcare-
Levofloxacin 750 mg PO/IV q24h ADD Linezolid 600 mg PO/IV q12h OR previous resistance noted:
Associated
(if macroaspiration ADD Metronidazole 500 mg Vancomycin 25 mg/kg IV load, then 15 mg/kg Substitute Ciprofloxacin with
Pneumonia
PO/IV q12h) IV q12h Tobramycin 7 mg/kg IV q24h unless
OR Legionella suspected.
(hospitalization in an
Amoxicillin/Clavulanate 500/125 mg PO TID If fluroquinolone contraindicated or previous
acute care hospital for
resistance noted: Depending on season or travel
≥2 days within the 5
If previous XDRO : Substitute Levofloxacin or Ciprofloxacin with history: Consider ADDING
prior 90 days; IV
Ertapenem 1 g IV q24h (doesn’t cover Tobramycin 7 mg/kg IV q24h unless Oseltamivir 75 mg PO BID
therapy, wound care
Pseudomonas spp.) Legionella suspected.
of IV chemo within the
Swab for MRSA (nasal/rectal/throat)
prior 30 days;
Depending on season or travel history: Consider Depending on season or travel history: as necessary
residence in nursing
ADDING Oseltamivir 75 mg PO BID Consider ADDING Oseltamivir 75 mg PO BID
home or other LTC
facility; attendance at
Swab for MRSA (nasal/rectal/throat) as Swab for MRSA (nasal/rectal/throat) as
a hospital or
necessary necessary
hemodialysis clinic
within the prior 30
days)

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Antibiotic Naïve: Piperacillin/Tazobactam 4.5 g IV q6h Piperacillin/Tazobactam 4.5 g IV q6h
Cefoxitin 2 g IV q6h + Metronidazole 500 mg + Tobramycin 7 mg/kg IV x 1 dose + Tobramycin 7 mg/kg IV q24h
PO/IV q12h + Vancomycin 25 mg/kg IV load,
Severe PCN allergy: then 15 mg/kg IV q12h
Non-severe PCN allergy: Meropenem 1 g IV q8h
Ceftriaxone 2 g IV q24h + Metronidazole 500 mg OR Severe PCN allergy:
PO/IV q12h Levofloxacin 750mg IV q24h + Vancomycin Meropenem 1 g IV q8h
Failed previous antibiotics or acquired after 7 25 mg/kg IV load, then 15 mg/kg IV q12h + Tobramycin 7 mg/kg IV q24h
days in hospital: + Tobramycin 7 mg/kg IV q24h + Vancomycin 25 mg/kg IV load,
Ertapenem 1 g IV q24h (as long as no history of + Metronidazole 500 mg IV q12h then 15 mg/kg IV q12h
Pseudomonas spp.)
OR Ascending cholangitis or Enterococcus spp. in Ascending cholangitis or perforation:
Piperacillin/Tazobactam 4.5 g IV q6h (as long as blood or MRSA: Consider ADDING Caspofungin 70 mg
Intra-Abdominal no history of XDRO5 / ESBL) ADD Vancomycin 25 mg/kg IV load, then 15 IV first dose then 50 mg IV q24h
mg/kg IV q12h
(Source control critical Severe PCN allergy:
for almost all Levofloxacin 750 mg PO/IV q24h
infections) + Metronidazole 500 mg PO/IV q12h
+ Tobramycin 7 mg/kg IV x 1 dose
MRSA confirmed or suspected:
ADD Vancomycin 25 mg/kg IV load, then 15
mg/kg IV q12h

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
In Absence of Indwelling Foley Catheter or Urinary Stent
1. Cipro/Levo
as per Early Pyelo Pip/Tazo & Cipro Mero & Cipro
ADD Ceftriaxone 1g x 1 dose (Renal Sparing)
OR Tobra 5mg/kg x 1 dose If penicillin allergy:
IF previous Cipro resistance or use in past 6 Mero & Cipro OR
mths
Mero & Tobra
2. Ampicillin & Ceftazidime
3. Pip/Tazo

Urinary Tract In Presence of Indwelling Foley Catheter or Urinary Stent

Infection (Catheter should be removed or changed)

(for complete 1. Pip/Tazo Mero, Vanco & Fluconazole As above, PLUS:

treatment 2. Meropenem
recommendations ADD Cipro or Tobra ADD Vanco (or Linezolid if VRE is a
refer to ASSC UTI If previous culture (in past 90d) or stat gram IF previous growth of P. aeruginosa (90d). concern)
Empiric Treatment points to yeast, Enterococcus or MRSA: add
Guidelines) appropriate therapy. ADD Fluconazole, Voriconazole, or
Amphotericin-B

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Exceptions: Human and animal bites, fresh Clindamycin 900 mg IV q8h Clindamycin 900 mg IV q8h
water, salt water contact, or concern for + Piperacillin/Tazobactam 4.5 g IV q6h + Meropenem 1 g IV q8h (administer
Pseudomonas spp. “Sneakers” ARE NOT (administer Clindamycin rapidly first or at the Clindamycin rapidly first or at the
covered below. same time) same time)

Cefazolin 2 g IV x 1 dose then 1 g (<70kg) or Severe PCN allergy: Source control critical. Consider
2 g (≥70kg) IV q8h Clindamycin 900 mg IV q8h STAT consults to Surgery and
+ Meropenem 1 g IV q8h (administer Infectious Disease.
Cellulitis,
If severe PCN allergy or MRSA suspected: Clindamycin rapidly first or at the same time)
Erysipelas and
Vancomycin 25 mg/kg IV load, then 15 mg/kg IV If Infectious Disease opinion not
Necrotizing Fasciitis
q12h MRSA confirmed or suspected: readily available:
ADD Vancomycin 25 mg/kg IV load, then 15 ADD Vancomycin 25 mg/kg IV load,
(for complete
If wound foul smelling: mg/kg IV q12h then 15 mg/kg IV q12h
treatment
ADD Metronidazole 500 mg PO/IV q12h for
recommendations
anaerobic coverage Consider IVIG for necrotizing fasciitis (1 g/kg Consider IVIG for necrotizing
refer to PAAT SSTI
day 1 and 0.5 g/kg days 2 and 3) if suspected fasciitis (1 g/kg day 1 and 0.5 g/kg
Empiric Treatment
or known Staphylococcus aureus or Group A days 2 and 3) if suspected or known
Guidelines)
Streptococcus infection. Staphylococcus aureus or Group A
Streptococcus infection.
Fournier’s gangrene
(pelvic/genital area
gangrene) suspected:
same treatment as
Severe Sepsis

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Cefazolin 1 g (<70kg) or 2 g (≥70kg) IV q8h Piperacillin/Tazobactam 4.5 g IV q6h + Meropenem 1 g IV q8h
OR Vancomycin 25 mg/kg IV load, then 15 mg/kg + [Tobramycin 7 mg/kg IV q24h OR
Ceftriaxone 1 g (<70kg) or 2 g (≥70kg) IV q24h IV q12h Ciprofloxacin 400 mg IV q12h (renal
MRSA suspected: sparing)]
ADD TMP/SMX 1-2 DS tablets PO BID Severe PCN allergy, known ESBL, foreign + (Vancomycin 25 mg/kg IV load,
travel in past year or antibiotic failure: then 15 mg/kg IV q12h OR
MRSA confirmed or severe PCN allergy: Meropenem 1 g IV q8h + Vancomycin 25 Daptomycin* 8-10 mg/kg IV q24h)
Vancomycin 25 mg/kg IV load, then 15 mg/kg IV mg/kg IV load, then 15 mg/kg IV q12h
q12h. STAT Gram stain of ulcer to exclude Source control critical. Consider
significant Gram negatives. STAT consults to Orthopedics and
If antibiotics in past 3 months or foul smell and Infectious Disease.
Diabetic Foot NOT Pseudomonas spp.:
Infection (Ceftriaxone 1 g (<70kg) or 2 g (≥70kg) IV q24h +
Metronidazole 500 mg PO/IV q12h) *Daptomycin use is limited to
(for complete OR patients having a true allergy to
treatment Ertapenem 1 g IV q24h
recommendations Vancomycin IV or upon the opinion
refer to PAAT SSTI MRSA confirmed or suspected: of an Infectious Disease
Empiric Treatment ADD Vancomycin 25 mg/kg IV load, then 15 consultant.
Guidelines) mg/kg IV q12h
Severe PCN allergy: consult ID
If Pseudomonas spp. a concern (e.g. previous
Pseudomonas, green exudate, severe immune
deficiency) :
Piperacillin/Tazobactam 4.5 g IV q6h
MRSA confirmed or suspected:
ADD Vancomycin 25 mg/kg IV load, then 15
mg/kg IV q12h
Severe PCN allergy: consult ID

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
For Meningitis: Dexamethasone 10 mg IV q6h x 4 days
Give Dexamethasone 15-20 minutes before, or with, the first dose of antibiotics.
Do not give Dexamethasone if: unable to meet the above timing recommendations OR recent neurosurgery.
Stop Dexamethasone if no evidence of Streptococcus pneumoniae

Ceftriaxone 2 g IV q12h + Vancomycin 25 mg/kg IV load, then 15 mg/kg IV q12h

ADD Ampicillin 2 g IV q4h if septic shock or refractory septic shock, immunocompromised, alcoholic, pregnant, or > 50 years of age

Recent neurosurgery: Ceftazidime 2 g IV q8h + Vancomycin 25 mg/kg IV load, then 15 mg/kg IV q12h ADD Metronidazole 500 mg IV
q8h if Septic shock. Consider infectious disease consultation.

Severe PCN allergy: Meropenem 2 g IV q8h + Vancomycin 25 mg/kg IV load, then 15 mg/kg IV q12h

Encephalitis (including new onset seizures): see above and ADD Acyclovir 10 mg/kg IV q8h
Meningitis and
Encephalitis

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Admit: Piperacillin/Tazobactam 4.5 g IV q6h Meropenem 1 g IV q8h
Ceftazidime 2g IV q8h + Tobramycin 7 mg/kg IV q24h
OR PCN allergy or ESBL: Meropenem 1 g IV q8h + Vancomycin 25 mg/kg IV load,
Piperacillin/Tazobactam 3.375 g IV q6h (< 70 kg) then 15 mg/kg IV q12h.
OR 4.5 g IV q6h (≥ 70 kg) Recent history of resistant Pseudomonas
aeruginosa: ADD Tobramycin 7 mg/kg IV x 1 ADD Caspofungin 70 mg IV first dose
ADD Vancomycin 25 mg/kg IV load, then 15 dose then 50 mg IV q24h if:
mg/kg IV q12h after blood cultures if: 1) refractory septic shock;
1) severe mucositis; 2) MRSA colonized; 3) ADD Vancomycin 25 mg/kg IV load, then 15 2) septic shock for greater than 72
clinically apparent serious, catheter-related mg/kg IV q12h after blood cultures if: hours.
Febrile Neutropenia infection; 4) pneumonia; 5) No improvement in 1) severe mucositis; 2) MRSA colonized; 3) (Consult Inf. Dis. or Med Onc before
3-4 days clinically apparent serious, catheter-related starting Amphotericin B liposomal.)
(And not associated
infection; 4) pneumonia; 5) No improvement
with another Severe PCN allergy: Obtain blood cultures x 2 in 3-4 days
suspected source) START Ciprofloxacin 400 mg IV q12h and consult
Med Onc. or Infectious Disease for other ADD Caspofungin 70 mg IV first dose then 50
Consider Medical antibiotic suggestions mg IV q24h if no improvement in 4-5 days
Oncology Consult for
all potential Rapid outpatient protocol:
admissions. (Page Medical Oncologist or covering Associate
on-call to facilitate outpatient follow-up)
1) Defined as “low risk”
2) no previous fluoroquinolone in 90 days
3) no recent history of resistant organisms
4) no penicillin allergy (Consult if PCN allergy)
Ciprofloxacin 750 mg PO BID +
Amoxicillin/Clavulanate 500/125 mg PO TID

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.
 Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
SIRS / Sepsis Septic Shock &
Severe Sepsis
Refractory Septic Shock
SIRS Criteria (2 of 4) SIRS + ≥1 of 8+ Severe Sepsis criteria: Septic Shock = Severe Sepsis +
Suspected Source
Temperature >38.3<36.0; HR>90; Mottled; Anuria; Lactate > 2; Plt <100; vasopressor support
WBC <4 >12; RR>20 or PaCO2<32 Acute Kidney Injury; DIC; ARDS; Fast Refractory Septic Shock = Above
changing LOC. with multiple vasopressors
Clostridium difficile Vancomycin 125 mg PO QID x 14 days Vancomycin 500 mg PO/NG q6h + Metronidazole 500 mg IV q8h

(for complete In presence of ileus: In presence of ileus: ADD Vancomycin 500 mg PR q6h
treatment ADD Vancomycin 500 mg PR q6h
recommendations
refer to PAAT Cdiff
Empiric Treatment
Guidelines)
Ceftriaxone 2 g IV q24h + Levofloxacin 750 mg (Piperacillin/Tazobactam 4.5 g IV q6h OR Meropenem 1 g IV q8h
PO/IV q24h + Metronidazole 500 mg PO/IV Meropenem 1g IV q8h) + Vancomycin 25 + Ciprofloxacin 400 mg IV q12h
Unknown q12h mg/kg IV load, then 15 mg/kg IV q12h + Tobramycin 7 mg/kg IV x 1 dose
OR + [Vancomycin 25 mg/kg IV load,
(excluding Central Piperacillin/Tazobactam 4.5 g IV q6h Recent antibiotic use or suspected XDRO5: then 15 mg/kg IV q12h OR Linezolid
Nervous System ADD Tobramycin 7 mg/kg IV q24h 600 mg PO/IV q12h (if VRE is a
infection) concern)]
Consider Infectious Disease opinion
Consider Infectious Disease opinion

Approved: February, 2014 This document is designed to aid Prince Edward Island hospital and community practitioners in the appropriate utilization of antimicrobials. Next Review: February, 2016
It does not serve as a substitute for clinical judgment or consultation with Infectious Disease experts.