Page 26 - Medicine and Surgery

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22 Chapter 1: Principles and practice of medicine and surgery

Refractory hypotension despite adequate volume re- be treated with cefuroxime, gentamicin and metron-
placement requires the use of inotropic agents such as idazole. Septicaemia from the urinary tract should
adrenaline, noradrenaline, dopamine or dobutamine be treated with a cephalosporin and gentamicin. If
in an intensive care setting. Pseudomonas infection is suspected piperacillin or
Identification and management of underlying causes ciprofloxacin are effective.

may require surgical intervention or the removal of Other treatments such as immunoglobulin, anticy-
indwelling catheters or lines. tokine antibodies, recombinant protein C and nitric
Antibiotic therapy should be based on local guidelines oxide synthetase inhibitors are under investigation.

and chosen on the basis of presumed infection source Steroids and nonsteroidal anti-inflammatory agents
until the results of microbiological investigations are have not been shown to be of benefit.
known. Septicaemia originating in skin and soft tis-
sue infections requires flucloxacillin and benzylpeni- Prognosis
cillin. If methicillin resistant Staph. aureus (MRSA) is The reported mortality from septicaemia ranges from
suspected vancomycin or teicoplanin should be used. 15 to 50% depending on the severity of sepsis and the
Septicaemia following intestinal perforation should general status of the patient prior to the illness.