Clinical management of Septicaemia in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Fever (>38.5°C) or hypothermia. Rigors, chills, altered mental status. Tachycardia and hypotension. Signs of primary site of infection (e.g., pneumonia, UTI). Toxic shock is a complication.
Investigations
Blood: WBC count, culture and sensitivity (use aseptic technique, collect before antibiotics). Identify primary source of infection. Culture from appropriate sites (urine, sputum, wound swab).
Emergency Management
General Measures (HC3/HC4)
Refer to hospital after pre-referral antibiotic dose. IV access. IV Normal Saline for resuscitation. Oxygen therapy. Blood cultures before starting antibiotics if possible.
Empirical Antibiotic (HC3)
Gentamicin 7 mg/kg IV every 24 hours. PLUS Ampicillin 2 g IV every 6 hours. Child: Gentamicin 7.5 mg/kg daily + Ampicillin 50 mg/kg every 6 hours.
Empirical Antibiotic (HC4 — Hospital)
Ceftriaxone 2 g IV every 24 hours. Child: 100 mg/kg once daily. If Staphylococcus suspected: add Cloxacillin 1–2 g IV every 6 hours. If anaerobic infection suspected: add Metronidazole 500 mg IV every 8 hours.
Septic Shock Management
Aggressive IV fluid resuscitation: 20–30 ml/kg of Normal Saline rapidly. Vasopressors if BP not restored. Corticosteroids if refractory shock. ICU admission. Surgical drainage of any collections.
De-escalation
Change to targeted antibiotic when culture and sensitivity results available. Total duration depends on source — typically 7–14 days.
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