Table 3.

Suggested empiric antimicrobial coverage in children with sepsis

Clinical situation	Antibiotic regimen
Sepsis without a defined focus	Ceftriaxone
Sepsis without a defined focus of nosocomial origin	Associate vancomycin
Neonates	Ampicillin + third generation cephalosporin (cefotaxime) + acyclovir (if suspicion of HSV infection)
Suspected genitourinary source	Associate aminoglycoside (e.g., gentamicin)
Suspected atypical pneumonia	Associate azithromycin
Suspected staphylococcal toxic shock syndrome	Associate clindamycin
Suspected encephalitis	Associate acyclovir
Suspected intra-abdominal source	Associate piperacillin with tazobactam, clindamycin, or metronidazole
Suspected COVID-19-related illness (PIMS-TS/MIS-C)	Ceftriaxone. Associate clindamycin if shock
Central venous catheter	Vancomycin + anti-pseudomonal cephalosporin (e.g., cefepime) or piperacillin-tazobactam) or meropenem
Immunocompromise or at risk for infection with Pseudomonas species	Anti-pseudomonal cephalosporin (e.g., cefepime) or meropenem in settings where bacterial organisms with extended-spectrum beta-lactamase (ESBL) resistance are prevalent or for patients who have been recently (within 2 weeks) treated with broad-spectrum antibiotics (e.g. third-generation cephalosporin or fluoroquinolone) Associate vancomycin if risk factors for MRSA are present
Increased risk of fungal infection (e.g. immunocompromised with persistent fever on broad-spectrum antibiotics):	Associate liposomal amphotericin B or an echinocandin (e.g., caspofungin and micafungin)
Risk factors for rickettsial infection (e.g. travel to or reside in an endemic region):	Associate tetracycline antibiotic (e.g., doxycycline)
Allergic to penicillin or recently received broad-spectrum antibiotics	Meropenem Associate vancomycin if risk factors for MRSA are present