Published in:
Open Access 01-04-2012 | Erratum
Erratum to: Recommendations for sepsis management in resource-limited settings
Published in: Intensive Care Medicine | Issue 4/2012
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The recommendation to use artesunate by suppositories (8–16 mg/kg at 0 and 12 h and then daily) if injectable artesunate is unavailable should not have been included in Table 8. The corrected table is given here.
Table 8
Management of sepsis due to specific causes
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Malaria
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Prompt start of parenteral artesunate in adults and children (2.4 mg/kg STAT followed by the same dose at 12 h, 24 h, and then daily until oral medication can be taken) (LoE: A)
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If injectable artesunate is unavailable intramuscular artemether (3.2 mg/kg on admission followed by 1.6 mg/kg daily), or intravenous quinine (20 mg/kg loading dose over 4 h followed by 10 mg/kg over 4 h 8 hourly until oral medication is possible) can be used (LoE: A)
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In children, parenteral antibiotics should be given in addition to antimalarial treatment (LoE: A)
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Parenteral antibiotics should be given to adults with slide proven malaria and who present with a clinical syndrome requiring parenteral antibiotics (meningitis/encephalopathy, malnutrition, very severe or severe pneumonia) (LoE: A)
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Seizures should be treated with rectal or intravenous diazepam, intravenous lorazepam, paraldehyde or other standard anticonvulsants (LoE: B)
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In the absence of shock, fluid management should be performed judiciously and more restrictively than in patients with bacterial sepsis (LoE: B)
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In case of severe anemia (e.g., hemoglobin level <6 g/dL), blood transfusion should be considered (LoE: A)
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Empirical antibiotic therapy needs to cover Gram-positive, Gram-negative and anaerobic bacteria (LoE: B)
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Puerperal sepsis
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Treatment of tuberculosis infection in resource-limited settings is best performed by timely initiation of the combination of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by isoniazid and rifampicin alone for another 4 months (LoE: A)
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Septic patients with HIV/AIDS
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Patients with open mycobaterial infections require isolation/cohorting (LoE: A)
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In Pneumocystis jiroveci pneumonia, the therapy of choice is trimethoprim/sulfamethoxazole administered for 3 weeks. In patients with hypoxemia, prednisolone (40 mg bid for 5 days followed by 40 mg/day for 5 days and then 20 mg/day for 11 days) should be added (LoE: B)
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In malnourished patients, energy supply should be re-started slowly with a stepwise increase of daily caloric intake and avoidance of large amounts of carbohydrates to prevent the re-feeding syndrome (LoE: B)
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