Table 4.

Guidelines pertaining to antimicrobial therapy in sepsis

Guideline	Evidence level
1. Intravenous antibiotic therapy should be started within the first hour of the recognition of severe sepsis, after appropriate cultures have been obtained. It is also recommended that premixed antibiotics should be available to increase the likelihood of early administration	5
2. Choice of initial antibiotics should be empirical, but should clearly be guided by the clinical picture and the sensitivity patterns of local pathogens	4
3. Broad-spectrum antibiotics should be used until the causative organism is identified. At 48–72 hours, antibiotic treatment should be reviewed. At this point, the spectrum should be narrowed if appropriate. The rationale for this recommendation is that it will help to contain costs and reduce the risk of emergence of resistant organisms. The duration of treatment should typically be 7–10 days and guided by clinical response	5
4. Some experts prefer combination therapy for patients with Pseudomonas infections, regardless of sensitivities	5
5. Most experts would continue to use combination therapy for neutropenic patients with severe sepsis or septic shock	5
6. If the presenting SIRS is determined to be due to a noninfective cause, antibiotic therapy should be stopped promptly to minimize the risk of development of resistant pathogens	5

SIRS, systemic inflammatory response syndrome.