ED Pathway for Evaluation/Treatment of Infants > 28 Days of Age and Children with Severe Sepsis

ANTIBIOTIC RECOMMENDATIONS FOR PATIENTS WITH SUSPECTED SEPTIC SHOCK

Healthy Patient
No Central Line
Patient with:
Oncology Patient
Patient with Suspected
Intraabdominal Source
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  1. Ceftriaxone
  2. Vancomycin
  1. Cefepime
  2. Vancomycin
  1. Cefepime
  2. Vancomycin
  3. Gentamicin
  1. Piperacillin/Tazobactam
  2. Vancomycin

IF TOXIN MEDIATED SYNDROME: CONSIDER ADDITION OF CLINDAYMYCIN

Cephalosporin allergy: Ciprofloxacin replaces cephalosporin

Penicillin allergy: Cefepime replaces piperacillin/tazobactam

If suspected intraabdominal source, add metronidazole for anaerobic coverage in place of piperacillin/tazobactam

If suspected CNS source and intraabdominal source, cefepime replaces piperacillin-tazobactam and add metronidazole for anaerobic coverageDosing

*Patient receiving the following medications:

  • Oral or SQ methotrexate > 5 mg
  • Prednisone 2 mg/kg/day or >20 mg daily (> 2 weeks)
  • Cyclophosphamide
  • Rituximab
  • Mycophenolate mofetil
  • Azathioprine
  • Anakinra
  • Infliximab
  • Etanercept
  • Adalimumab

Dosing & administration:

CHOP Formulary

Use Sepsis Order Set