Pharmacotherapeutics of Septecemia

1. SEPTECEMIA
Dr. V. S. Swathi
Assistant Professor

2. Definition
It is a condition where invasion of the blood
stream by virulent microorganisms and
especially bacteria along with their toxins
from the local site of infection accompanied
especially by chills, fever and extreme
weakness.

3. Epidemiology
 Septicaemia affects more than 30 million people
worldwide every year leading to 6 million
deaths
 More than 90, 000 people die every year in
India due to sepsis

4. Types
 Gram positive bacterial sepsis- Sepsis is
caused by gram positive bacteria
 Gram negative bacterial sepsis- Sepsis is
caused by gram negative bacteria
 Anaerobic bacterial sepsis- Sepsis is
caused by anaerobes
 Fungal sepsis- Sepsis is caused by fungi

5. Risk factors
 Older age
 Comorbid conditions like:
 Acute leukaemia
 Aplastic anemia
 Prolonged granulocytopenia
 Cirrhosis
 HIV
 Diabetes
 Chronic renal failure

6.  Prolonged use of broad spectrum
antibiotics
 Corticosteroid treatment
 Prolonged hospitalization
 Presence of central venous catheter
 Total Parentral nutrition treatment

7. Aetiology
Gram positive bacteria
 Staphylococcus aureus
 Streptococcus pneumoniae
 Coagulase negative staphylococci species
 Enterococcus species
Gram negative bacteria
 Escherichia coli
 Klebsiella species
 Pseudomonas aeruginosa
 Serratia species
 Enterobacter
 Proteus

8. Anaerobic bacteria
 Bacterides fragilis
 Clostridium species
Fungus
 Candida albicans
 Candida glabrata
 Candida parapsilosis
 Candida tropicalis
 Candida krusei
 Crypotococcus species
 Cocidioides species
 Fusarium species
 Aspergillus species

9. Pathogenesis

12. Balance between release of pro
inflammatory mediators and anti
inflammatory mediators determines degree
of inflammation:
 Local antibacterial activity
 Systemic tissue toxicity
 Organ failure
 Death

13. Clinical Presentation
Early sepsis (within 6 hours)
 Rigors
 Tachycardia
 Tachypnea
 Nausea
 Vomiting
 Hyperglycaemia
 Myalgia
 Proteinuria
 Hypoxia
 Leucocytosis
 Hyperbilirubinemia
 Delirium

14. Late sepsis (after 6 hours)
 Lactic acidosis
 Oliguria
 Leukopenia
 Thrombocytopenia
 GI haemorrhage
 Coma
 Myocardial depression
 Pulmonary oedema
 Hypotension
 Hypoglycaemia
 Azotaemia
 ARDS

16. Complications
 Shock
 Disseminated intravascular coagulation
(DIC)
 Acute respiratory distress syndrome
(ARDS)
 Multiple organ failure

17. Disseminated Intravascular
Coagulation(DIC)

18. Diagnosis
 Clinical presentation
 Culture tests
 Lab tests
 Computed tomography
 Magnetic resonance imaging
 Procalcitonin levels
 C-reactive protein levels

19. Non Pharmacological
Treatment
 Fluid resuscitation
 Urinary catheterisation
 Intubation
 Mechanical ventilation

21. Treatment Algorithm

22.  Antibiotics
Respiratory tract infection
 Pipercillin+ Tazobactam
 Ceftriaxone
 Ceftazidime
 Levofloxacin
 Ciprofloxacin
 Azithromycin
 Clarithromycin
 Amikacin

23. Urinary tract infection
 Ceftriaxone
 Ceftazidime
 Ciprofloxacin
 Levofloxacin

24. Intraabdominal infection
 Pipercillin+ Tazobactam
 Levofloxacin
 Ciprofloxacin
 Metronidazole
 Carbapenam

25. Skin and soft tissue infections
 Pipercillin+ Tazobactam
 Linezolid
 Daptomycin
Catheter related infections
 Pipercillin+ Tazobactam
 Ceftazidime
 Cefipime
 Imipenam
 Meropenam
 Vancomycin

26. Fungal infections
 Amphotericin B
 Fluconazole
Viral infections
 Oseltamivir
 Zanamivir

27. Drug Category Mode of action Dose Adverse effects
Pipercellin+
Tazobactam
Penicillin+ Beta
lactamase
inhibitor
Inhibit bacterial cell
wall synthesis
+ Inhibit Beta
lactamase enzyme in
microbes
3-375g-OD- 7-10
days
 Diarrhoea
 Insomnia
 Dyspepsia
 Pruritis
 Fever
Ceftrioxone Cephalosporin Inhibit bacterial cell
wall synthesis
2g-IV-OD-7-10days  Injection site
reaction
 Eosinophilia
 Thrombocytosis
 Diarrhoea
 Transaminitis
Levofloxacin Fluroquinolone Inhibit bacterial
protein synthesis
500mg-OD-7-10
days
 Diarrhoea
 Insomnia
 Constipation
 Dizziness
 Dyspepsia

28. Azithromycin Macrolides Inhibit bacterial protein
synthesis
500mg-OD-7-10
days
 Diarrhoea
 Abdominal pain
 Vaginitis
 Dyspepsia
 Malaise
Metronidazole Miscellaneous
antibiotics
Inhibit DNA synthesis
in microbes
1.5-7.5mg/kg-7-10
days
 Anorexia
 Candidiasis
 Dark urination
 Furry tongue
 Metallic taste
Noradrenaline Vasopressor Stimulate adrenergic
receptors on heart and
increase cardiac output
0.01-3mcg/kg/min  Bradycardia
 Hypertension
 Arrhythmias
 Anxiety
 Dyspnoea
Adrenaline Vasopressor Stimulate adrenergic
receptors on heart and
blood vessels leads to
increase in cardiac
output and
vasoconstriction
0.05-2mcg/kg/min  Angina
 Arrhythmias
 Dyspnoea
 Hypertension
 Palpitations

29. Dopamine Vasopressor Stimulate
dopaminergic
receptors on heart and
blood vessels leads to
increase in cardiac
output and renal
vasodilatation
1-5mcg/kg/min  Dyspnoea
 Anxiety
 Azotemia
 Pilorection
 Glaucoma
Dobutamine Inotropic agent Stimulate adrenergic
receptors on heart and
blood vessels leads to
increase in cardiac
output and
vasoconstriction
0.5-1mcg/kg/min  Arrhythmias
 Hypertension
 Angina
 Dyspnoea
 Palpitations
Hydrocortisone Corticosteroids Reduces inflammatory
mediator responses
200mg-OD-IV  Acne
 Arthralgia
 Cataract
 Cushing
syndrome
 Decreased
wound healing

30. Resources
 https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5578903/pdf/nihms867772.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4499724/pdf/bmjopen-2014-006564.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C6023165/pdf/pone.0180705.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4943374/?report=printable
 https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C6066934/pdf/12936_2018_Article_2430.pdf