Subsequent actions

• Discuss with senior colleague.

• Amend antibiotics according to culture results or to suit likely source if cultures negative.

• Check aminoglycoside trough levels after loading dose and before second dose as renal impairment may determine reducing or withholding next dose. Consider switch to non-nephrotoxic cover e.g. cef-tazidime/ciprofloxacin.

• Continue antibiotics for 7-10d minimum and usually until neutrophil recovery.

• If cultures show central line to be source of sepsis, remove immediately if patient not responding.

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