Clinical features

The features are similar to those seen in HIV-negative patients. Treatment

The choice of empirical antibiotic therapy is dictated by the situation, but normally would provide cover for all common Gram-positive and Gram-negative bacteria, including Pseudomonas species, with an agent such as ceftazidime 2 g intravenously twice daily. Specific agents should be added in the following circumstances: with associated diarrhea give ciprofloxacin 500 mg intravenously twice daily (for Salmonellae); with a pre-existing central catheter in place give vancomycin 500 mg intravenously four times daily (for resistant Gram-positive cocci); if there is profound neutropenia (< 0.1 * 10 9/l), give gentamicin 5 mg/kg/day divided into three doses; if abdominal sepsis is suspected, give metronidazole 500 mg intravenously three times daily.

Critical care

Management is the same as for any hypotensive septic patient. Forty per cent of such patients treated in the intensive care unit (ICU) will survive to leave hospital.

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