Dawaa Reference

infectious

Suspected Sepsis (Emergency Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Surviving Sepsis Campaign Guidelines 2021 · NICE Guideline NG51: Sepsis 2016 (updated 2024) · Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary-care prescription. · Egyptian National Drug Formulary - Antimicrobial 2023

Verified against2 documents
  • Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary-care prescription.
  • Egyptian National Drug Formulary - Antimicrobial 2023

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • The picture varies enormously with where the patient sits between a systemic inflammatory response and full septic shock [shock]
  • Illnesses that worsen the outlook: active cancer, diabetes, chronic lung disease, heart failure, kidney impairment and cirrhosis [cirrhosis]
  • Being older than 65 years old independently predicts death, as adaptive immunity weakens with age
  • Sex does not appear to change mortality; the studies disagree
  • Any of those coexisting illnesses should raise the suspicion and push you to act sooner
  • Ask about recent illness, time in hospital and contact with drug-resistant organisms, since these steer the choice of treatment
  • The commonest sources, in order, are pneumonia, infection inside the abdomen, and urinary infection
  • Death is not tied to which site or which organism, resistant ones included, yet finding the source early still matters

Signs — what you find (9)

  • Examination supplies the vital signs, which is what makes any bedside screening possible
  • Whatever the criticism of scoring, watching for abnormal vital signs and a body-wide response to infection still holds good
  • The lungs fail as acute respiratory distress syndrome [breathlessness]
  • The circulation fails as septic shock, meaning low blood pressure [hypotension · shock]
  • The kidneys fail as acute kidney injury
  • The brain fails as septic encephalopathy [sepsis]
  • The marrow fails as the anaemia of critical illness [anaemia]
  • Muscle and peripheral nerve fail as critical illness myopathy and polyneuropathy
  • Take the vitals fast, then examine thoroughly for a source, including a pelvic examination where that is relevant

Tests (12)

  • There is no reference-standard test for sepsis, which is why no bedside tool catches every case
  • Diagnosis rests on three things together: body-wide features, evidence of failing organs, and microbiology
  • Failing organs show up in platelets, bilirubin, INR, creatinine and lactate, among other markers
  • Microbiology usually means blood cultures, and can extend to urine, peritoneal or joint fluid, respiratory secretions and CSF
  • In over a third of clinical sepsis cases the blood cultures come back negative, and contaminants muddy the picture further
  • Organ dysfunction markers: systolic below 90 mm Hg, mean arterial pressure below 65 mm Hg, or respiratory failure needing ventilation
  • More markers: creatinine over 2.0, urine output under 0.5 ml/kg/hour across 2 consecutive hours, total bilirubin over 2 mg/dl
  • And: platelets under 100,000, INR above 1.5, aPTT above 60 seconds, or lactate above 2 mmol/L
  • Core workup is a full blood count with differential, a comprehensive metabolic profile, lactate, and clotting
  • The critical lactate value is greater than 2 mmol/L; INR and aPTT climb acutely as organs fail
  • Chest film and urinalysis hunt the source; take at least 2 blood cultures before the antibiotic, plus cultures from any likely site
  • Of uncertain value: procalcitonin, CRP, lipase, venous gas, a DIC panel, TSH, rapid flu and virus panels, and CT or spinal MRI depending on the suspected site

If not this — what else fits (12)

  • Adrenal insufficiency
  • Thyrotoxicosis
  • Salicylate poisoning
  • Anticholinergic poisoning
  • Malignant hyperthermia
  • Neuroleptic malignant syndrome
  • Heat stroke
  • Major trauma
  • Pancreatitis
  • Anaphylaxis
  • Extensive burns
  • The other kinds of shock: cardiogenic, obstructive and hypovolaemic

Scores

  • WHO Emergency Triage (sick child) — Is this sick child safe to wait?
  • qSOFA (quick SOFA) — Is this infection likely to go badly?

SourceStatPearls "Bacterial Sepsis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (EMERGENCY REFERRAL)

1st line
Dose source

Septic Shock - StatPearls (NCBI Bookshelf NBK430939) - https://www.ncbi.nlm.nih.gov/books/NBK430939/: "early identification remains the best therapeutic tool for sepsis treatment and management." and "Broad-spectrum antibiotics within one hour of diagnosis for all patients." - which is hospital care, not a primary-care prescription.

Why

Sepsis is a medical emergency requiring rapid hospital transfer for diagnostic blood cultures, IV fluid resuscitation, and broad-spectrum IV antimicrobials within the first hour.

Cautions
  • TIME-CRITICAL EMERGENCY: Red flag signs include altered mental status, systolic BP <90 mmHg, respiratory rate >=22/min, non-blanching rash, or anuria.
  • Do not delay hospital transport for primary care procedures; communicate suspected sepsis to receiving emergency department.
2

CEFTRIAXONE

add-on - not a substitute

Strength1000 mg

Forminjection

Adult dose and duration

IV or IM 1–2 g once or devided twice daily.

Paediatric dose

80 mg/kg/dose [child max 2000 mg]

(Severe infection (eg, meningitis, penicillin-resistant pneumococcal pneumonia): 100 mg/kg/day divided every 12 to 24 hours; maximum daily dose: 4,000 mg/day)

Dose by weight
3kg240 mg/dose
4kg320 mg/dose
5kg400 mg/dose
6kg480 mg/dose
7kg560 mg/dose
8kg640 mg/dose
9kg720 mg/dose
10kg800 mg/dose
11kg880 mg/dose
12kg960 mg/dose
13kg1040 mg/dose
14kg1120 mg/dose
15kg1200 mg/dose
16kg1280 mg/dose
17kg1360 mg/dose
18kg1440 mg/dose
19kg1520 mg/dose
20kg1600 mg/dose
21kg1680 mg/dose
22kg1760 mg/dose
23kg1840 mg/dose
24kg1920 mg/dose
25kg2000 mg/dose
26kg2000 mg/dose (capped)
27kg2000 mg/dose (capped)
28kg2000 mg/dose (capped)
29kg2000 mg/dose (capped)
30kg2000 mg/dose (capped)
31kg2000 mg/dose (capped)
32kg2000 mg/dose (capped)
33kg2000 mg/dose (capped)
34kg2000 mg/dose (capped)
35kg2000 mg/dose (capped)
36kg2000 mg/dose (capped)
37kg2000 mg/dose (capped)
38kg2000 mg/dose (capped)
39kg2000 mg/dose (capped)
40kg2000 mg/dose (capped)
41kg2000 mg/dose (capped)
42kg2000 mg/dose (capped)
43kg2000 mg/dose (capped)
44kg2000 mg/dose (capped)
45kg2000 mg/dose (capped)
46kg2000 mg/dose (capped)
47kg2000 mg/dose (capped)
48kg2000 mg/dose (capped)
49kg2000 mg/dose (capped)
50kg2000 mg/dose (capped)
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

NICE NG51 permits pre-hospital broad-spectrum IV/IM antibiotic administration when hospital transfer is delayed by over 1 hour.

Cautions
  • Only administer pre-hospital antibiotics if it does not delay immediate emergency transfer.
  • Contraindicated in patients with severe cephalosporin or penicillin anaphylaxis.
  • The formulary's paediatric figure for a severe infection is 100 mg/kg/day, maximum 4 g, and 50 mg/kg every 24 hours in a neonate.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZOXIDEL 1 GM PD. FOR I.M. INJ.RAMEDA > DELTA PHARMA22.00 EGP
CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)KAHIRA29.00 EGP
ZOXIDEL 1 GM PD. FOR I.V. INJ.RAMEDA > DELTA PHARMA29.00 EGP
WINTRIAXONE 1 GM PD. FOR I.V INJ.SANOFI48.00 EGP
VOTRIAXONE 1 GM I.M VIALCHEMIPHARM56.00 EGP
OFRAMAX 1 GM I.M. VIALRAMEDA > SUN PHARMA EGYPT LIMITED71.00 EGP
TRIAXONE 1 GM I.M. VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
TRIAXONE 1 GM I.V VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.