Empirical Antibiotic Treatment for Septic Shock

Initial Antibiotic Selection

The Society of Critical Care Medicine recommends that intravenous antimicrobials must be initiated as soon as possible and within one hour of recognizing septic shock to reduce mortality 1, 2
Empiric broad-spectrum therapy should cover all likely pathogens (bacterial, potentially fungal or viral) 1, 2
For septic shock, use combination therapy with at least two antibiotics from different antimicrobial classes 1, 2
For respiratory failure with septic shock: combine an extended-spectrum β-lactam with either an aminoglycoside or fluoroquinolone when Pseudomonas aeruginosa is suspected 1, 2
For septic shock from Streptococcus pneumoniae bacteremia: combine a β-lactam with a macrolide 1, 2

Empiric combination therapy should not be administered for more than 3-5 days 1, 2
De-escalation to the most appropriate single therapy should be performed once susceptibility profile is known 1, 2
Daily assessment for de-escalation of antimicrobial therapy is recommended 1, 2
Standard duration for serious infections associated with sepsis and septic shock is 7-10 days 1, 2

Longer courses may be appropriate in patients with slow clinical response to initial therapy 1, 2
Longer courses may be appropriate in patients with undrainable foci of infection 1, 2
Longer courses may be appropriate in patients with bacteremia with Staphylococcus aureus 1, 2
Longer courses may be appropriate in patients with fungal and viral infections 1, 2
Longer courses may be appropriate in patients with immunologic deficiencies, including neutropenia 1, 2

Optimize antibiotic dosing strategies based on pharmacokinetic/pharmacodynamic principles 1, 2

Failure to de-escalate: Continuing broad-spectrum antibiotics beyond 3-5 days when culture results are available increases resistance risk 1, 2
Inappropriate duration: Treating longer than necessary (typically >10 days) without specific indications 1, 2
Antimicrobial agents should not be used in patients with severe inflammatory states determined to be of noninfectious cause 1, 2