Gram-negative sepsis
Life-threatening organ dysfunction caused by infection with gram-negative pathogens (E. coli, Klebsiella, Pseudomonas). Gentamicin is included in empirical regimens for suspected gram-negative bacteremia before culture and susceptibility data are available.
ICD-10 A41.52 drugs
Also known as: Enterobacterales bacteremia
Drugs used for this condition
- AMeropenemFirst line · Carbapenem antibiotic for intravenous useMeropenem is a hospital carbapenem, and in gram-negative sepsis it goes in where earlier beta-lactams no longer hold the flora: extended-spectrum beta-lactamase producers, Pseudomonas aeruginosa, Acinetobacter. The AEMPS Archifar label names bacteraemia associated with a severe infection as a separate entry and allows the drug from 3 months of age. Dosing follows creatinine clearance, and in renal failure the interval stretches. An extended 3-hour infusion keeps the concentration above the MIC longer than a bolus, and severe sepsis is dosed that way. Once cultures return, the regimen narrows: the carbapenem stays only for confirmed resistant flora. If the patient takes valproic acid, the treating neurologist hears about the meropenem start: the anticonvulsant level collapses within two days.
- BGentamicinAdd-on therapy · Aminoglycoside antibioticGentamicin is included in empirical regimens for suspected gram-negative bacteremia or sepsis in combination with a broad-spectrum beta-lactam. Surviving Sepsis Campaign 2021 recommends dual gram-negative coverage on day 1 in unstable patients and where multidrug-resistant pathogens are likely. After susceptibility data and patient stabilization, therapy is de-escalated. Once-daily dosing (5–7 mg/kg) is preferred for efficacy and safety, supported by the 2014 Cochrane review.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit