Adjunctive treatments may reduce morbidity and mortality and include dexamethasone for bacterial meningitis; intravenous immunoglobulin (IVIg) for TSS and necrotizing fasciitis caused by group A Streptococcus; low-dose hydrocortisone and fludrocortisone for septic shock; and drotrecogin alfa (activated), also known as recombinant human activated protein C, for meningococcemia and severe sepsis. Adjunctive therapies should usually be initiated within the first hours of treatment; however, dexamethasone for bacterial meningitis must be given before or at the time of the first dose of antibiotic. Specific Presentations The infections considered below according to common clinical presentation can have rapidly catastrophic outcomes, and their immediate recognition. | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 3 Adjunctive treatments may reduce morbidity and mortality and include dexamethasone for bacterial meningitis intravenous immunoglobulin IVIg for TSS and necrotizing fasciitis caused by group A Streptococcus low-dose hydrocortisone and fludrocortisone for septic shock and drotrecogin alfa activated also known as recombinant human activated protein C for meningococcemia and severe sepsis. Adjunctive therapies should usually be initiated within the first hours of treatment however dexamethasone for bacterial meningitis must be given before or at the time of the first dose of antibiotic. Specific Presentations The infections considered below according to common clinical presentation can have rapidly catastrophic outcomes and their immediate recognition and treatment can be life-saving. Recommended empirical therapeutic regimens are presented in Table 115-1. Sepsis Without an Obvious Focus of Primary Infection These patients initially have a brief prodrome of nonspecific symptoms and signs that progresses quickly to hemodynamic instability with hypotension tachycardia tachypnea respiratory distress and altered mental status. Disseminated intravascular coagulation DIC with clinical evidence of a hemorrhagic diathesis is a poor prognostic sign. Septic Shock See also Chap. 265 Patients with bacteremia leading to septic shock may have a primary site of infection . pneumonia pyelonephritis or cholangitis that is not evident initially. Elderly patients with comorbid conditions hosts compromised by malignancy and neutropenia and patients who have recently undergone a surgical procedure or hospitalization are at increased risk for an adverse outcome. Gram-negative bacteremia with organisms such as Pseudomonas aeruginosa or Escherichia coli and gram-positive infection with organisms such as Staphylococcus aureus or group A streptococci can present as intractable hypotension and multiorgan failure. .
