Septic shock, hypotension, lactate >4mmol/L, or end-organ failure

and

  • previous ESBL/ampC-producing organism

  • recent piperacillin-tazobactam therapy
    or

  • recent 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