Septic shock, hypotension, lactate >4mmol/L, or end-organ failure
and
previous ESBL/ampC-producing organism
recent piperacillin-tazobactam therapy
orrecent travel (patient/close contact) to South Asia
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Imipenem | 500mg IV q6h | 7-10 days |
| or | ||
| Meropenem] | 500mg IV q6h | |
| + | ||
| Vancomycin | 25-30mg/kg IV once then 15mg/kg IV q8-12h |
Carbapenem allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin | 400mg IV q12h | 7-10 days |
| + | ||
| [Gentamicin | 7mg/kg IV daily | |
| or | ||
| Tobramycin] | 7mg/kg IV daily | |
| + | ||
| Metronidazole | 500mg IV q12h | |
| + | ||
| Vancomycin | 25-30mg/kg IV once then 15mg/kg IV q8-12h |