How are empiric antimicrobial therapies selected for the treatment of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Initial selection of particular antimicrobial agents is empiric and is based on an assessment of the patient’s underlying host defenses, the potential sources of infection, and the most likely pathogens.

Antibiotics must be broad-spectrum and must cover gram-positive, gram-negative, and anaerobic bacteria because all of these classes of organisms produce identical clinical pictures. Administer antibiotics parenterally in doses high enough to achieve bactericidal serum levels. Many studies have found that clinical improvement correlates with the achievement of serum bactericidal levels rather than with the number of antibiotics administered.

Coverage directed against anaerobes is particularly important in the treatment of patients with intra-abdominal or perineal infections. Antipseudomonal coverage is indicated in patients with neutropenia or burns.

Patients who are immunocompetent generally can be treated with a single drug that provides broad-spectrum coverage, such as a third-generation cephalosporin. However, patients who are immunocompromised usually must be treated with 2 broad-spectrum antibiotics that provide overlapping coverage. Within these general guidelines, no single combination of antibiotics is clearly superior to any other.

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