1. Septicaemia

Take cultures

Assess the likely site of origin and see appropriate table (e.g. section 8 Gastrointestinal system for biliary sepsis)

Non-neutropenic sepsis

For septicaemia of unknown origin, use a carbapenem + gentamicin. Refer to table below - choice dependent on renal function. See schedule for once daily dosing of gentamicin.

Neutropenic sepsis

For neutropenic sepsis, give a carbapenem + gentamicin and assess after 24 hours.

Consult microbiology.

Dosing schedule for carbapenems

Renal Function	Serum Creatinine (mmol/L approx.)	GFR (ml/min)	Drug	Dose
Normal	Males 60-90 Females 40-90	120 (approx.)	Imipenem	500mg QDS
Mild Impairment	150-300	31-70	Imipenem	500mg every 8 hours
Moderate Impairment	300-700	10-30	Meropenem	500mg every 12 hours
Severe Impairment	>700	<10	Meropenem	500mg every 24 hours

If history of CNS disease (e.g. epilepsy, head injury) and renal impairment risk of seizures with imipenem

Note: The categories of renal impairment used here are specific for imipenem and are not transferable to other drugs.

Calculation of Creatinine Clearance