Duration of Treatment for Cellulitis and Myositis with Septic Shock

Initial Antibiotic Management

Intravenous antimicrobials should be initiated as soon as possible and within one hour of recognition of septic shock 1
Empiric broad-spectrum therapy should be used initially to cover all likely pathogens 1
For septic shock, combination therapy using at least two antibiotics of different antimicrobial classes is suggested for initial management 2
Obtain appropriate cultures, including at least two sets of blood cultures, before starting antibiotics (if no significant delay) 3

Standard duration for serious infections associated with sepsis and septic shock is 7-10 days 1, 4
Combination therapy should not be administered for more than 3-5 days; de-escalation to the most appropriate single therapy should be performed once susceptibility profile is known 2, 4

Slow clinical response to initial therapy may require longer treatment duration 1, 2
Undrainable foci of infection may require longer treatment duration 1, 2
Bacteremia, especially with a common bacteria, may require longer treatment duration 1, 2
Immunologic deficiencies, including low white blood cell count, may require longer treatment duration 1, 2

Daily assessment for de-escalation of antimicrobial therapy is recommended 2
Antimicrobial regimen should be reassessed daily for potential de-escalation 4
Consider using a biomarker to support shortening the duration of antimicrobial therapy 2

Source control (drainage of any purulent collections) should be performed within the first 12 hours if feasible 1, 3
The presence of septic shock indicates severe infection, which may necessitate treatment at the upper end of the recommended duration range 1, 2